A Life in Medicine in Chicago

Charles Martinez, a longtime physician and author from Chicago, talks about his life and career.

What is The Clinical Excellence Podcast?

The Clinical Excellent Podcast, sponsored by the Bucksbaum Institute for Clinical Excellence is a biweekly podcast hosted by Drs. Adam Cifu and Matthew Sorrentino. The podcast has three formats: discussions between doctors and patients, discussions with authors of research pertinent to improving clinical care and the doctor-patient relationship and discussions with physicians about challenges in the doctor-patient relationship or in the life of a physician.

[00:00:00] Dr. Cifu: On today's episode of The Clinical Excellence Podcast, we have Dr. Charles Martinez talking about decades of medicine in Chicago.

[00:00:12] Dr. Martinez: You know, I started before there was CAT scanning, MRI, ultrasound, so I used to tell the students, they'd say, "What did you do?" And I said, "Well, we were doing history and physical and an autopsy."

That's not a nice thing to say, but it's a little exaggeration.

[00:00:35] Dr. Cifu: We're back with another episode of The Clinical Excellence Podcast, sponsored by the Bucksbaum Institute. On this podcast, we speak to patients and doctors about all aspects of excellence in clinical medicine. I am Adam Cifu, and today I'm joined by Dr. Charles Martinez. Dr. Martinez has had a long and successful career in medicine in Chicago.

After graduating from St. Louis University Medical School in 1961, he completed his internship at Rush Presbyterian - St. Luke's Medical Center, Chicago, and residencies in internal medicine and nuclear medicine at the Hines VA. He served as director of the Division of Nuclear Medicine at Lutheran General Hospital in Park Ridge from 1984 to 2002.

Dr. Martinez is also the medical director and one of the founders of the Old Irving Park Community Clinic. Charlie is also the author of Under the L: A Chronicle of Growing Up in the Near North Side of Chicago in the 1930s, 1940s, and 1950s. I've just finished it and loved it. I can definitely recommend it. It's a memoir and an oral history of kind of growing up and, I got to say, surviving. So Dr. Martinez, thank you so much for taking time out of your life to be here with me.

So I have a couple of questions for you, but first of all, I kind of wanted to hear just a little bit about your career. I read you were an English major at Loyola and like, how did you get from there to the present, I guess?

[00:02:05] Dr. Martinez: Well, actually the only thing I ever wanted to be was a writer. Didn't do much about it. And then, I went for two years to a place called Quigley. Have you heard of it?

[00:02:20] Dr. Cifu: No, I have not.

[00:02:21] Dr. Martinez: It's a high school for people who are going to be priests. My mother was Irish, and every Irish mother had to have one of their sons. So I went there for two years, flunked Latin both years. But anyway, then I left, I went to Loyola downtown. And I was there a year or so, enjoying it. And then I came out of the building one day and I saw two or three guys from my class at Quigley. And they said, "What are you doing?" And I said, "Well, I'm majoring in English." And they went, "Who majors in English?" They said, "Why don't you get into pre-med?" I said, "For what?" They said, "You might get into medical school." And I said, "Okay." That was my total involvement to be a doctor.

[00:03:09] Dr. Cifu: I love it. I love it. So, you know, you're definitely not the, you know... I feel like I talk to people who, "Geez, I know since birth, you know, I was meant to be a doctor," but I've certainly heard a lot of people, my father being one of them, who just, you know, sort of decided later in life, or it was like, I don't want to say the path of least resistance, but it's like, "Oh, here's something I can do. And I'll probably have a job if I do this." When was it then, kind of in your schooling, in your training, that you recognized, like, "Wow, you know, this is something I love, this is something I want to do!"

[00:03:44] Dr. Martinez: Well, there wasn't a wow but I found out that I could do it pretty easily, which was bad because I didn't study. But the idea of being involved with patients came very naturally to me. I had no trouble with that and I found out, especially when I set up the clinic, that I had sort of a knack for drawing in all these specialists to help us, you know. And, this one young doctor who came there to... He was an internist who wanted to do some clinical stuff there. He said, "You have a different set of..." What is the word?

[00:04:27] Dr. Cifu: Like a skill set, I guess.

[00:04:28] Dr. Martinez: Yeah, a different skill set than he had. And he recognized this, and I didn't at the time. But that's how it went, and does that answer that question? Makes sense?

[00:04:41] Dr. Cifu: That did. And when I hear you talk about this, and when I think about, you know, what the world was kind of like as you were training, I mean, you started at the time where a hospital was, you know, just a hospital, right? And it wasn't some enormous medical center, which was taking over blocks and blocks in the city, right?

[00:04:59] Dr. Martinez: Gobbling up stuff.

[00:05:01] Dr. Cifu: Yeah. And also, you know, you must have been involved in nuclear medicine kind of at the beginning of the field.

[00:05:09] Dr. Martinez: Well, that was a lot of luck. See, I call myself the lucky life or the incidental life but what happened, I finished my internal medicine, you finish it always in June. And then there's no Boards till like October or November. So what do you do for three months? I didn't want to go into practice. So this guy says, "Why don't you hang around the Hines?" I said, "To do what?" He said, "Go do nuclear medicine." I said, "I don't even know what that is." So I did it, and it turned out, the head of nuclear medicine was a guy named Irv Kaplan. He was a pioneer. He sort of put... He had a lot... He invented the bone scan. He had other stuff to do with thyroid. Very nice, pleasant guy. And I said, "Can I hang around?" There was no residency there. He says, "Yeah." Okay. So then his buddy at Mount Sinai calls him and says, "You know, we want to reopen nuclear medicine. You got anybody you could send over?" And he says, "You know, now that you mention it," so he asked me and I said, "I only met her a couple of months. I can't go [unintelligible]." And he says, "I will come every Saturday with you." So he came every Saturday for 10 years.

[00:06:20] Dr. Cifu: Wow.

[00:06:20] Dr. Martinez: It degenerated into a social thing. But he was fantastic. And, we had a good time.

[00:06:26] Dr. Cifu: It's amazing. I mean, that's, you know, not only is it luck, but it's almost like an apprenticeship, you know, situation and also so casual compared to how things are now. And so tell me then, what your practice was like, you know, once you, you know, I guess, whatever, finished the internal medicine Boards, were you mostly doing internal medicine? Were you mostly doing nuclear medicine at the time?

[00:06:51] Dr. Martinez: Well, at Sinai I started hanging around with the endocrinologists, two of them, really smart guys. And so I would make rounds for them and do internal medicine and it was a lot of fun. And because there wasn't much to do in nuclear medicine at Sinai, just opening it up. Eventually, it got pretty busy. Then, one of the endocrinologists went to Lutheran. They had endocrinology there. Then he called me. He said, "I don't like the guy who's running nuclear medicine." You know, there was other things he said about it. He says, "Can you come and do it?" And I says, "Well..." You know, it was a nice thing at Sinai. There was 20 of us in a group, all internists. You know, and I was president. That's another story. I don't want to get into that, but anyway, so I decided, okay, but the guy I was replacing was suing the hospital for his job, and so it dragged for a year, you know, till things calmed down. So then I went there, and then my buddy, this is Don Gordon, he was the endocrinologist, he became head of medicine at Lutheran. And then, he left there about a year after I got there, went to Loyola, and became head of endocrine there. So I stayed for... See I was 15 years actually at Sinai.

[00:08:14] Dr. Cifu: Got it. And so it sounds like most of your practice was always in a way hospital-based. Yes?

[00:08:20] Dr. Martinez: Absolutely. I didn't even know what an outpatient was.

[00:08:23] Dr. Cifu: Yeah, yeah, yeah. And so you were taking care of patients who were hospitalized and it sounds like probably, you know, interacting, working with their primary doctors from the outside. Is that true?

[00:08:36] Dr. Martinez: Well...

[00:08:37] Dr. Cifu: I'm trying to get a sense of the system back there.

[00:08:39] Dr. Martinez: Yeah, I used to say that, you know, I don't know much about business, but I know how to give service. And we... I developed it into the busiest nuclear medicine facility in the area and the first outpatient PET, too. I used to come here and talk to a PET guy, you guys have a PET machine. And so, it got big and so I really didn't do any internal medicine.

Then I wanted to volunteer at a place that opened up, something like my place. And I went to the head of medicine and I said, "I'd like to volunteer down there." He says, "When was the last time you did internal medicine?" I said, "10 years ago." He says, "No." Then I realized I could have gone anyway.

[00:09:19] Dr. Cifu: Sure, sure. Well, so tell me about the Old Irving Park Community Clinic, like, how did that start up?

[00:09:26] Dr. Martinez: Well, there was a guy I grew up with who is in the book, although I changed his name.

[00:09:30] Dr. Cifu: Did you? Okay.

[00:09:31] Dr. Martinez: Yes. Well, anyway, he retired. He was a counselor, a behavioral health counselor, but he had a pretty sweet job at the time before he retired. He was a counselor for the electricians' union, which was really nice. So he said, "Why don't..." And then I was retiring, I was 72 and he was like 70, I guess.

[00:09:51] Dr. Cifu: What year was this?

[00:09:53] Dr. Martinez: That was in, uh, must have been...

[00:09:55] Dr. Cifu: Must have been 90s?

[00:09:56] Dr. Martinez: No, no. It was, uh, in 2005 or something because I was part-time. I went part-time at Lutheran for a while. And then I disagreed with the people there and left.

[00:10:09] Dr. Cifu: We don't need to go into that.

[00:10:09] Dr. Martinez: No. So then he says, "Why don't we rent an office? I'll do behavioral health and you can do medicine." I said, "No, I'm not interested." Then I went to a meeting, St. Louis [unintelligible], there was a guy there, what I thought was an old guy, he had opened up a free clinic down in Sarasota, Florida. And then I talked to him afterwards, I said, "How was it to open a place like that?" He said, "Piece of cake." And it was because we didn't know what we were doing. And it eliminates all this tension and anxiety and stuff. It flourished, you know? So we opened it up and now it's... How many years is it?

[00:10:48] Dr. Cifu: Sounds like it must be almost 20 years?

[00:10:49] Dr. Martinez: Well, I think we opened... I think it's 17.

[00:10:53] Dr. Cifu: Okay. Okay. And so not to get too much into the weeds with that but, you know, you already, I get the feeling, you know, you're quite an operator, right? With people.

How do you support something like that? Sort of, you know, where does the money come from?

[00:11:10] Dr. Martinez: You know, we went to Catholic schools and the nuns taught us how. That's what my partner always used to say. It's all donations and foundations.

[00:11:23] Dr. Cifu: Sure. Sure.

[00:11:24] Dr. Martinez: And we just have kept it up.

[00:11:26] Dr. Cifu: Right. And part of what's, I don't want to say easy about it, because I certainly know it's not easy, but not having to deal with the whole infrastructure of billing in American medicine.

[00:11:37] Dr. Martinez: Which I hate, yes. Doctors come there and they say this is their refuge. They can't... We have no billing department, you know, and they just can't stand that stuff. Well, you know that, how it is.

[00:11:50] Dr. Cifu: And who do you care for mostly? Sort of, what's the patient base kind of like?

[00:11:53] Dr. Martinez: Well, uh, ethic... Not ethically, what's that word?

[00:11:58] Dr. Cifu: Legally? Ethnically?

[00:12:02] Dr. Martinez: Yeah, that's it. Did I say ethically? Yeah, okay. Anyway, when we started out it was about 40 percent Hispanic, probably 20 percent Polish, and now it's about, what, 60 or 70 percent Hispanic. And they're all, you know, they can't have insurance. We don't see anybody with insurance.

And they don't pay anything. So I wandered around the hospitals, and I got them to offer us five free X-rays a month for three hospitals. And that worked out well. And then we get... We pay for the lab work, but we do Quest. And I'll give you an example of how cheap it is.

[00:12:44] Dr. Cifu: Yeah, yeah, yeah.

[00:12:45] Dr. Martinez: For a CBC, a comp, and what else, and drawing the blood, we don't draw blood there, and cholesterol. Well, that's 12 dollars.

[00:13:02] Dr. Cifu: I think they cut you a special deal.

[00:13:04] Dr. Martinez: Yeah. Well, I wanted it for nothing, and they claimed they didn't do that, but we knew they were giving this one place free blood test, but that's pretty good. So we pay for that.

[00:13:17] Dr. Cifu: And medications?

[00:13:20] Dr. Martinez: Medications. Well, 90 percent of our medications, the patients pay themselves four bucks. The expensive ones we get directly from the company.

[00:13:29] Dr. Cifu: Great. And then how about referrals? I mean, there must be people who need surgery, need specialty referrals.

[00:13:34] Dr. Martinez: Yeah, well, physically at the clinic, we have subspecialists come, GI, there's eight of them, cardiology, GI, the whole thing. And then for surgery, we usually have to send them to County. And then there are specialists on the outside. We'll see them in their office for nothing. I have to make a phone call.

[00:13:58] Dr. Cifu: Sure, sure, sure. And do you have a sense, like, how many people do you, you know, see in a year? How many people are you...

[00:14:05] Dr. Martinez: A strange thing has happened since COVID. Our patient load has dropped in half. But how many were we seeing? We were probably seeing several hundred a week.

And we were pretty busy. It was fun. Of course, we have no limits. They'd come, the doctors would come and we say, "Here's what we like. If you can spend two days a month is best. Two half days, for sure." Then you keep track of the patients better. And then, we don't care if you see one patient for three hours, you know, because you know what's going on.

[00:14:41] Dr. Cifu: Yeah, absolutely.

[00:14:42] Dr. Martinez: It's terrible. And so they love it.

[00:14:44] Dr. Cifu: Right. That's what I was going to say. That's where you say it's a refuge for the doctors, right? To sort of practice the medicine they want to.

[00:14:51] Dr. Martinez: We've got all these students. We have 27 schools sending people to us for PA, medical students, and NPs, and official rotations.

We don't take them all at once, obviously. But you know, it's fun to be around these guys.

[00:15:09] Dr. Cifu: No, I mean, it's probably...

[00:15:10] Dr. Martinez: They do all the scout work.

[00:15:12] Dr. Cifu: I was going to say, it's probably not only good medicine, but also seeing... You know, practice in this kind of setting must be eye-opening to people.

[00:15:21] Dr. Martinez: Yeah. I mean, they're shocked. You know, they can't believe it.

[00:15:25] Dr. Cifu: So, you're a young man. So what's next for you? Sort of, what do you see as like...

[00:15:31] Dr. Martinez: See, now?

[00:15:31] Dr. Cifu: Absolutely.

[00:15:32] Dr. Martinez: I'm a young man. I'm 89. Well, I guess I have to retire at some point.

[00:15:41] Dr. Cifu: Retire for a second time, right?

[00:15:42] Dr. Martinez: Yeah. But I've got, you know, I used to golf. Not very good. And then, I got my writing which I still do quite a bit. And then, that's it. Then you're waiting around for the big opening in the sky, I guess.

[00:15:59] Dr. Cifu: No, but you're, it sounds like you're happy sort of doing the clinical work and continue to do that.

[00:16:03] Dr. Martinez: I always enjoy it. Enjoy, you know, talking to patients. They're so thankful for what we're doing. I remember this one lady I saw, she was about 40-something. And I mean, the student, we were ready to walk out after we finished. She says, "Can I say something?" And I said, "Yeah." She says, "I'm so thankful that you talked to me and examined me completely and all this. Nobody ever did that before." You know, you wonder, what's going on?

[00:16:32] Dr. Cifu: Yeah, it's wonderful. Have you guys been affected by the, you know, more recent influx of, you know, of all of the migrants coming in?

[00:16:42] Dr. Martinez: Well, I did see some migrants across from a police station. And then they got dispersed. So now a church close by is turning their old school and another building into a migrant shelter. And I've been in contact with them. I'll come there with people and then some med students and stuff, but they're fixing the place up, so it's dragging.

[00:17:06] Dr. Cifu: Yeah, sure, sure. That's good to hear. We've certainly been experiencing that mostly in our emergency room, which is difficult because it ends up being emergency care and you're like, what comes next? It is absolutely a challenge. So Dr. Martinez, again, I wanted to thank you for your time. It's really interesting.

It's great for me as someone who's only been in the city for whatever, 26 years and feel like I know Chicago well to talk to you and hear more about it with a longer vision of the place.

[00:17:38] Dr. Martinez: Is this it?

[00:17:39] Dr. Cifu: We can talk about anything. What else do you want to say?

[00:17:44] Dr. Martinez: Well, there's a couple of things.

Going to... I'm one of 11 kids, and there's no medical stuff in my family, so I have had a lot of unusual jobs as I go through medical school. As a senior student, I invented myself as an ER physician. Got another six guys, we went to the small hospital and ran the ER. Because at that time, you didn't have to have a doctor in the hospital. Then Missouri passed a law, you had to have a doctor 24 hours a day. Then when I was in residency, I became a coroner's physician. And that was an interesting job.

[00:18:27] Dr. Cifu: What did that mean? What were you doing?

[00:18:29] Dr. Martinez: Well, you see, there's so many dead bodies that they didn't want to hire a lot of pathologists. So if you could go and get a decent history and feel comfortable signing the death certificate... That was an exciting job.

[00:18:40] Dr. Cifu: So you would talk to relatives, friends, whoever was around to try to piece together what had happened.

[00:18:44] Dr. Martinez: Yeah, a lot of suicides, a lot of... I don't want to say I liked it, but it was a different side. And then I worked for a year, remember Dunning?

[00:18:53] Dr. Cifu: Yep, yep.

[00:18:54] Dr. Martinez: I worked for a year there, right out of residency. You know, we were all drafted. Were you drafted?

[00:18:59] Dr. Cifu: No, no, I was after that.

[00:19:01] Dr. Martinez: Oh yeah, so I was two years in. Did you ever hear of the Battle of Long Beach, California?

[00:19:07] Dr. Cifu: No. No.

[00:19:08] Dr. Martinez: There was one.

[00:19:10] Dr. Cifu: But you fought in it.

[00:19:10] Dr. Martinez: Yeah. I was there for two years. I lucked out. I could have gone to Vietnam or something, you know. And then, all kinds of jobs like that.

[00:19:19] Dr. Cifu: I'm making a note because it sounds like, you know, you were an internal medicine physician at a time that there were internal medicine physicians. You were an ER doctor before there were really ER doctors.

[00:19:30] Dr. Martinez: Well, the other six guys were surgeons, they took the other days and I was the only internist.

[00:19:36] Dr. Cifu: It's funny, when I trained, it was just when we were beginning to have, you know, Board-certified ER doctors but we had a surgical side of the emergency room, a medical side of the emergency room, the triage nurse would decide where you'd go. And there was essentially a possession arrow for abdominal pain. So it would alternate back and forth, so you got to see everything. You were nuclear medicine at the beginning of nuclear medicine and then I'm going to call you a forensic interviewer as a field which I think only existed under you.

[00:20:06] Dr. Martinez: What the hell is that?

[00:20:07] Dr. Cifu: That's what you were doing, figuring out what to put on a death certificate without any extra information.

[00:20:15] Dr. Martinez: But you know, the big thing you learned when you got into the free clinic is how it is not to have insurance. I'll give you one bad example. This 25-year-old woman came, ulcerative colitis, bleeding, and we had a GI guy then, and... We still have him. And so we got Humira, and he said, "I can take her to the hospital, just Resurrection Hospital because my patient was the nun who was president, and she would do anything for me."

So that's kind of... So he takes her there. She immediately has a reaction to Humira. So she calls me, she says, "What should I do?" I says, "Well, you know..." Should I tell you? "Go to the University of Chicago. They're big on GI." So she calls me a week later. She says, "Well, I went there, and they said I wasn't sick enough to be admitted, and they gave me a card to see the GI doctor for 600 dollars." And she was a student part-time. And I said, "Well, one thing you can do is go back there and show yourself. You'll collapse."

[00:21:19] Dr. Cifu: Wait a week until you're sicker then go back.

[00:21:21] Dr. Martinez: Well she didn't. She went to Rush and they did a total colectomy.

[00:21:25] Dr. Cifu: Oh my god.

[00:21:26] Dr. Martinez: This is what happens when you don't have insurance.

[00:21:28] Dr. Cifu: Yeah. Yeah.

Don't you feel like that that's... I always feel like that's one of the gifts of medicine, right? That because you work with people who you would never sort of meet in your regular life, right? You get such a sense of what life is like in any profession, any job that people have. And right, what it's like living with a billion dollars or 10 dollars. Right? And I feel like most of our social circles are so limited, that it's really wonderful to have that experience with people.

[00:22:03] Dr. Martinez: Yeah. It was fun. I always like to use the word fun. If you're not having fun, what is the point?

[00:22:09] Dr. Cifu: Right, right, right. Now, looking at you, you clearly are someone who's enjoyed, you know, not only what the career has given you, but kind of what life has given you.

[00:22:17] Dr. Martinez: You know, I started before there was CAT scanning, MRI, ultrasound. So I used to tell the students, they'd say, "What did you do??" And I said, "Well, we would do a history and physical and an autopsy." That's not a nice thing to say. It's a little exaggeration.

[00:22:34] Dr. Cifu: You admit that the physical exam is not a perfect tool and that you were doing a lot of guessing.

[00:22:39] Dr. Martinez: Yeah, but I still push the history and physical, I said, medicine is 90 percent history.

[00:22:45] Dr. Cifu: It absolutely is, it absolutely is.

[00:22:46] Dr. Martinez: So we get people... The terrible thing is happening in medicine: the timing. What this one student was telling us that, a nurse it was, that a corporation bought the hospital, and they put up clocks on the outside of the door. And you had to hit that as a nurse, when you're going in, and hit it when you come out, so the nurses figured out how to beat it. They'd hit it going in, and if they left, they had like a nurse's aide, if she's staying doing something, they hit it when she leaves, so it looks like they're putting in more time, or something, I don't know.

One time we had a nurse practitioner student on an official rotation and she told me she got a call, they have to keep a log, got a call from one of the administrators asking why she was spending so much time with the patients. That's... It's unbelievable.

[00:23:45] Dr. Cifu: Yeah. Yeah. Yeah.

[00:23:46] Dr. Martinez: You must hear this all the time.

[00:23:48] Dr. Cifu: Oh, there's no question about it.

[00:23:50] Dr. Martinez: That's what you're getting into.

[00:23:52] Dr. Cifu: Hey, I'm at the other side. I'm at the end as well. Not quite as far. I'm going to do the wrap-up here.

[00:24:01] Dr. Martinez: Okay.

[00:24:02] Dr. Cifu: Thanks for joining us for this episode of The Clinical Excellence Podcast. We are sponsored by the Bucksbaum Institute for Clinical Excellence at the University of Chicago. Please feel free to reach out to us with your thoughts and ideas via the Bucksbaum Institute web page or on X, otherwise known as Twitter.

The music for The Clinical Excellence Podcast is courtesy of Dr. Maylyn Martinez