Chapter 9 begins with Vance’s descent into depressive isolation worsening. His mother demands he provide her with clean urine, so she can pass a urinalysis and keep her nursing job. Vance explodes, calling both his mom and Mamaw out on their poor parenting, then admitting to Mamaw that his own urine may not be drug-free due to experimenting with Ken’s marijuana. Mamaw assuages these concerns and persuades Vance to give his urine to Bev.

By the end of his sophomore year, Bev has moved out of Ken’s home, and Vance is living with Mamaw in Middletown. Vance provides more detail on Mamaw, explaining why she returns to Kentucky less and less throughout her life. “It was the place where she sometimes went hungry as a child, from which she ran in the wake of a teenage pregnancy scandal, and where too many of her friends had given their lives to the mines. I wanted to escape to Jackson; she had escaped from it” (134).

Vance enjoys living with Mamaw and sees Lindsay and her son, Kameron, often. Mamaw undergoes unnecessary back surgery for a broken hip, demanding the family bring her Taco Bell while she recoups in a rest home.