Eastern Kentucky’s former coal heartland now faces a health crisis as advanced black lung disease surges among younger miners. New mining methods and weak safety measures are blamed. The story follows Glenn Salyer, 48, whose rapid decline and death reflects a region struggling with the collapse of its coal-driven identity.

Early morning in Pikeville, Kentucky.
Glenn and his wife during a sermon at the Faith Baptist Church in Dorton, Kentucky.
Glenn stops his truck to catch for breath and is in pain. Robinson Creek, Kentucky.
At the X-ray machine of Dr. James Brandon Crum of the United Medical Group, Pikeville, Kentucky.
Glenn enters his truck after Bible class and a meeting at the Faith Baptist Church in Dorton, Kentucky.
Glenn had the best sense of humour, telling jokes in his truck if his breath would allow him. On the way to Pikeville, Kentucky.
Glenn and his mother watching TV together. Robinson Creek, Kentucky.
Glenn receives a little comfort from his wife while trying to BBQ scallops. Sookeys Creek, Kentucky.
Glenn and his family at the Faith Baptist Church in Dorton, Kentucky.
Glenn in his truck driving toward Virgie, Kentucky.
Glenn showing his last mine that he worked at in Virgie, Kentucky.
Looking out at a strip-mine in Wise County, Virginia from Lynch, Kentucky.
Coal transport belts near Jenkins, Kentucky.
Arriving at the Pikeville Medical Center in Pikeville, Kentucky.
Glenn drops off his mother at her home in Sookeys Creek, Kentucky.
Glenn has to stop every few meters to catch his breath, Pikeville Medical Center, Kentucky.
Glenn says a final goodbye to the staff of the Black Lung Clinic in Pikeville, Kentucky.
On the way to a Food Court in Glenn truck. Robinson Creek, Kentucky.
Glenn in his kitchen beginning to struggle breathing without oxygen. Sookeys Creek, KY.
Glenn together with his wife, two daughters, son-in-law and visitor in their living room in Sookeys Creek, Kentucky.
Out on the patio in Sookeys Creek, Kentucky.
Glenn is really starting to suffer the effects of not being able to breathe and has to stop driving until the pain eases a bit. Virgie, Kentucky.
Glenn and his wife buying charcoal for the BBQ at a Food City in Pikeville, Kentucky.
Glenn slow BBQing chicken for 3 hours in his back yard, Robinson Creek, Kentucky.
An old coal hopper near Harlan, Kentucky.
Glenn and his wife wait for bible class to start at the Faith Baptist Church, Dorton, Kentucky.
Glenn on his way to prepare for the night. He doesn’t dare to sleep in bed anymore fearing that he might suffocate if he rolls onto his back so he sleeps on the sofa. Robinson Creek, KY.
Glenn has lost a lot of weight in the last two years, putting on a clean shirt. Robinson Creek, Kentucky.
Glenn sleeps on the sofa now because he doesn’t dare to sleep in bed anymore fearing that he might suffocate if he rolls onto his back. Robinson Creek, Kentucky.
Glenn shows his wedding photograph. Robinson Creek, Kentucky.
The Salyer’s family house in Robinson Creek late at night.
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