"How are you doing? What's the word?" Butler asks.

Butler scans her medical chart and congratulates her for lowering her blood pressure. They talk about her acid reflux and her trouble breathing, and about seeing a lung specialist. He gently reminds her she needs to lose weight.

"You seem like you are doing better, as a package," Butler tells her.

"Yeah, I was a mess," she says.

"You said it — not me," he responds, smiling.

Greene was uninsured and had few options for medical care until she recently received Medi-Cal coverage. But she plans to stick with the clinic. "When I had nothing, didn't have insurance, they really took care of me," she said.

But another patient in the waiting room, Jesus Sarellano, 63, with thick glasses and a salt-and-pepper mustache, said he plans to leave when he qualifies for Medicare. Sarellano first came to the clinic four years ago when he lost insurance coverage at the hardware store where he worked.

He likes that the clinic is free and he can get his medications for hypertension, high cholesterol and asthma, but he wishes it had more specialized staff and equipment. "When I need an X-ray, they have to send me somewhere else."

In his call to the pharmacy, nurse practitioner Tomlin discovers Rosemary Ricks isn't due for a refill for two more weeks. Back in the examination room, Ricks admits she had been doubling up on pills to manage the pain. Tomlin tells her she'll have to wait for a refill.

"What am I supposed to do for the pain?" Ricks asks, her eyes welling with tears. Without medication, she says, she has only one option — the emergency room.

"Sorry, Mrs. Ricks, there is not much I can do for you," he says apologetically. "Come back and see me in two weeks, if you are still having problems."

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Times staff writer Anna Gorman reported aspects of this story while participating in the California Endowment Health Journalism Fellowships, a program of USC's Annenberg School of Journalism.