One morning this spring, Claudia Cox, a registered nurse in Jackson, Miss., drove toward the countryside to visit some patients. She often has trouble finding their homes. “The rural people are the worst,” she said. “ ‘Come to the oak tree.’ Well, hell, I’m from the city, I don’t know what no oak tree is. I know magnolia. I know pine trees.” Cox referred to her seven-year-old Ford Freestyle as her “office,” but it had the ambience of an arcade: the ding-ding-ding from her dashboard signaling an unbuckled seat belt, the whir of a phone charger in the cigarette lighter, the phone ringing with the opening of Cheryl Lynn’s disco hit “Got to Be Real.” Cox, a 45-year-old divorced mother of three, juggled phone calls and patients’ charts and cigarettes like some serene octopus, always catching the steering wheel just before the vehicle veered onto the grass. After 20 minutes, she pulled into a pebbly driveway. It was time to find out why Vonda Wells kept going back to the emergency room.


Cox works for an agency called HealthConnect, whose purpose is to reduce admissions to the Central Mississippi Medical Center, a Jackson hospital where people routinely use the emergency room for primary care, sometimes multiple times in a month.


Wells’s large figure filled the door frame of the tiny house. She was jovial despite the oxygen tube that ran to her nose. She held a baby. “Is that yours?” Cox exclaimed.


“That’s my grandbaby!” Wells said and passed the baby off to a teenager who disappeared behind a closed door. The two women sat down in a dark living room cramped with couches.


“All right, Ms. Wells, we come out and check on everybody,” Cox said. “You had pneumonia, right?”


“I went to Florida, and that’s where I first got sick, at the Holy Land.”


“O.K.,” Cox scribbled, and then looked up. “What’s that?”


“It’s an amusement park out there, but it has Jerusalem, it has Noah’s Ark, they did the play the Passion . . .”


“Now there’s another spot for me and my baby to go!” Cox said. They laughed.


Cox doesn’t know oak trees, but she knows how to talk to people. She knows when to ask if someone cannot afford insulin, or is not taking insulin, or is not keeping the insulin cold, or cannot keep the insulin cold because there is no electricity or refrigerator. Not having health insurance is a huge problem in Mississippi, but it isn’t the only one. “So you good with doing your medicines?” Wells made a guilty face. “You oxygen-dependent?” She was.


Wells worked at a Jackson hospital as a certified nursing assistant for five years before she started getting sick with asthma-related illnesses. No one wanted a nurse who needed an oxygen tank, she said, so now she was trying to work a handful of hours a week at a Christian community center. “I stayed in Illinois for 25 years,” she said. “I didn’t really have asthma symptoms till I came down here.”


“There’s something in the house that’s triggering it,” Cox said. “I bet you need to get tested for mold.” She made a note. The house was old, the rug thick, the air damp. “And I’m putting a little check mark down here that you got the basic light, gas and water. Your major problem is the asthma.”


“And congestive heart failure.”


Cox tilted her head. “Have you been taught how to manage your congestive heart failure? Because you should have a scale.” She looked around the house gamely, as if she believed a scale might pop out from behind the TV.


“I need a scale?”


“You need a scale, and you need to do a weight every morning. Because if you get on a scale and there’s a three-pound difference from one day to the next, you’re starting to retain fluid. I see that your legs are already swollen.”