Iyasu Habtemicael - Izzy - drives a florist truck for $8 an hour most days and then works nights in a University of Pennsylvania parking garage.
This leaves him little time to exercise, eat right and manage his diabetes.
He also has no health insurance, relying on the city's busy free clinics for care.
Because of these factors, compounded by his own belief that he couldn't get in to see a doctor, Izzy nearly died last spring when his diabetes soared out of control.
In immense pain and vomiting blood, he went by ambulance to Mercy Philadelphia Hospital, where he spent five days in intensive care. The charges came to $41,000.
The nurse practitioner who treated him said it all could have been avoided if he'd had better access to a doctor.
Izzy, 33, a college-educated U.S. citizen, dreams of returning to his native Eritrea in East Africa to be a political science professor. He remembers arriving in the United States with his family when he was 9 years old on July 4, seeing fireworks on the car ride from the airport in New York to Philadelphia.
Izzy learned he had diabetes while at Indiana University of Pennsylvania. His father died from diseases related to diabetes a few years ago.
Izzy had an appointment to get blood work done on Feb. 14 - Valentine's Day, the busiest day of the year for a man who drives a flower truck.
Izzy knew a trip to the clinic could last all day, and he didn't want to let his boss down.
"Izzy is a very nice person," said Michael Toroghi, 64, who owns Roses Florist on the Penn campus. "I'm happy with his performance. He carries out his duty."
Izzy tried to get a new appointment, but just couldn't get through. Press one for English, then hold. . . . He would hold until he was disconnected, then try again. After a few tries, he gave up.
City clinics serve 85,000 Philadelphians who make 334,000 visits every year. Many patients, including Izzy, think the doctors are excellent and committed.
One problem is that it can take months to get a new appointment. A report last spring by the city controller found that it took on average 165 days for a clinic patient to see a primary-care physician. City health officials say that the average wait is down to 55 days and that they are working to reduce it further.
Even though Izzy missed his Valentine's Day appointment and was skipping insulin shots because of his hectic schedule, he thought he would be fine.
He had an appointment with his doctor at the clinic on May 29.
He figured he'd just wait until then.
