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thedrifter
11-26-06, 07:05 AM
A TOP SURGEON ENLISTS
Duty and honor: Dr. Martin Holland quit his job as UCSF department head to join the Navy
- John Koopman, Chronicle Staff Writer
Sunday, November 26, 2006

(11-26) 04:00 PST San Diego -- If Dr. Martin Holland had his way, he'd be in Iraq right now. In Fallujah or Ramadi or Baghdad. Up to his elbows in blood and brain matter, operating on Marines and soldiers with severe head injuries.

As it happens, it's unlikely the doctor will find himself hovering over a battlefield operating table. But he has a strong desire to serve -- to do something for the troops suffering severe combat injuries. Instead of teaching residents and interns how to stop intracranial bleeding in San Francisco, Holland is wearing Navy whites and operating on sailors and Marines in San Diego.

Holland is not an 18-year-old who joins the Marines fresh out of high school. He's 44, and he quit a prestigious job as director of neurotrauma at UC San Francisco. But there are similarities: Both put aside personal lives to enlist in the military.

They also serve who stand and operate.

"When I was a kid, I loved stories about knights in shining armor," he said. "There was something very appealing about the ideals of honor, courage and all that kind of stuff.

"The only thing I saw in the modern world that was even close to that code of chivalry was, one, the military, and two, was medicine with the Hippocratic oath."

Those are lofty words, but they do not appear to come from ego. Like most people who work in the highest echelons of their professions, Holland is a no-nonsense kind of guy. He is straightforward, intense, not given to frivolity. He does not offer comments about duty, honor and country, but they come easily when he is asked.

He's tall, over 6 feet, and looks a little like the actor Dean Winters, with close-cropped hair on the sides of his head, thinning on top. He wears Navy-blue scrubs and the standard doctor's white lab coat. He walks fast and speaks with the precision of a surgical instrument.

Holland was born in Mexico City, where his mother was from, during a trip there from the family home in Denver. Later, his father's job took the family to San Diego, where he grew up.

Holland's maternal grandfather was a surgeon in the Mexican army. His paternal grandfather was a colonel on Gen. Douglas MacArthur's staff in the Pacific during World War II. He died there. Details are sketchy, but Holland said his grandfather died of a head injury suffered in an airplane crash. It's unknown whether the crash was an accident or a result of combat.

After high school, Holland got his undergraduate degree from Stanford. He and his twin sister went to the University of Michigan for medical school. (She is now a pediatrician in Detroit.)

He did a seven-year residency at UCLA and then a year in Phoenix at the Barrow Neurological Institute. He had a fellowship to study skull-base vascular surgery, which is considered among the most demanding kinds of operations on the human body. The surgery generally involves the removal of tumors at the base of the skull, such as on the pituitary gland, and is complicated by the nerves and blood vessels tethered to the brain and descending from it.

"My surgical interests are things like aneurysms, whereas my intellectual interest is really in trauma," he said.

Holland worked for a year at Alameda County Medical Center and then interviewed for a position at UCSF. He would have pursued a career as a vascular neurosurgeon, but that position was filled. A position was open for director of neurotrauma, which is neurosurgery related to such trauma as auto accidents, falls or even gunshot wounds.

UCSF is affiliated with San Francisco General Hospital, and the doctors who teach at the university practice medicine at the hospital. Holland was responsible for operating on San Francisco patients who had suffered head trauma.

"Trauma is very much meatball surgery," he said. "You just try to get through it. The real challenge in trauma is the postsurgical treatment."

Holland understood that the key to helping patients was not so much in his skill with a scalpel. To really make an impact, he had to find a way to improve the efficiency of the medical treatment system. There are many phases, from triage to operations to post-op care to rehabilitation. He embarked on a project to rewrite the city's neurotrauma care plan.

That project coincided with the Sept. 11, 2001 attacks.

Holland, who is married to Ping, a cardiologist in private practice in San Francisco, said he wanted to quit his job and join the military then, but that would have meant shelving the UCSF project just getting under way.

So he waited. Worked as a surgeon. Developed the city plan. And wondered if he would ever get his chance to put on a uniform.

In late 2004, the plan was pretty much done and approved. In December that year, he picked up a phone and called a Navy recruiter. It must have been some phone call: "Hello, I'm the chief of neurotrauma surgery for the city of San Francisco, and I'd like to join the Navy."

Holland talked to the Navy for several months, trying to determine how to join and what he would do. In June 2005, he took the oath and entered the Navy at the rank of commander. He said the Navy offered to make him a captain, the equivalent of a colonel in the Army, because of his medical experience. But Holland didn't feel comfortable with such a high rank because of his lack of military background.

He spent five weeks in a specialized officer school, designed to acclimate professionals, such as doctors, nurses and lawyers, who join after already having established a career.

The indoctrination was partly physical and partly a crash course in military history, etiquette, traditions and such.

Holland was already an accomplished sailor and so he knew the difference between port and starboard, which is useful when you're in the Navy.

He chose the Navy for two reasons: because he grew up in San Diego, a Navy town, and because he respects and admires the Marine Corps. The Marines, unlike the Army, Air Force and Navy, do not have a medical corps and so rely on the Navy to provide doctors, medics and nurses.

After officer indoctrination, Holland was sent to the Balboa Naval Medical Center in San Diego, where he practices today.

He works in a nondescript office in the huge medical center. There is one window with a commanding view of an inside wall of the complex. A set of Navy dress whites hangs from the back of his door, and there are a handful of papers and knickknacks that say "Navy," but otherwise his office and his work are more about medicine than military.

He is one of four Navy neurosurgeons at Balboa.

When Holland joined, he asked to be sent to Iraq. As it happened, the Navy had pulled its neurosurgeons from Iraq. At one time, there were many from all the services because there are so many head wounds there. The head wound is the signature wound in Iraq because the vast majority of injuries come from roadside bombs. Even those troops who escape shrapnel suffer traumatic brain injury from the intensity of the blast, which will rattle a brain inside the skull.

Right now, troops with head wounds go through triage in Iraq and then are quickly flown to the Landstuhl Medical Center in Germany. From there, sailors and Marines go to the National Naval Medical Center in Bethesda, Md., and soldiers to the Walter Reed Army Medical Center in Washington.

There is a plan to rotate neurosurgeons from all the services in and out of Landstuhl for six-month tours, Holland said. That might be as close as he gets to Iraq.

Does that lessen his interest in serving in the Navy?

"No, not at all," he said. "Because here I have the opportunity to put into practice some of the things I learned in San Francisco, about systems and creating processes for getting the best care to the greatest number of people."

At Balboa, he's working on a program called C5, or Comprehensive Combat Casualty Care Center.

"Do we treat one patient, or do we treat all patients?" he asked. "Going to Iraq would mean I would treat one patient. Doing C5 means we can better treat all patients."

Still, Holland hasn't given up on going to Iraq.

"The one thing about going to Iraq is that I would get a flavor for what the various issues are," he said. "I can imagine what it's like to try to take care of somebody in a tent, but that's very different from actually being in the tent.

"Eventually, even if it's just on a short-term assignment, I'd love to go out, just for my own education."

Holland said his first responsibility is to be a neurosurgeon at Balboa and help out with the caseload. And that's just the way it is.

"I know what the military is like," he said. "I know that what you would like to do from the personal standpoint and what is right from the operational standpoint may not be the same."

Holland joined the Navy for a four-year hitch. He will have to determine by the end of that contract whether he wants to stay in.

Complicating matters is the fact that he became a father a couple of weeks ago. His wife gave birth in October to a baby girl named Katherine.

For the time being, they live a commuter life, flying between San Diego and San Francisco. The question down the road will be: continue to commute; leave the Navy and return to San Francisco; or have the family relocate to San Diego.

Dr. Lawrence Pitts, professor of neurosurgery at UCSF, said Holland did a terrific job in San Francisco. "Martin is extremely well-trained, and he is an outstanding surgeon," he said. "He's also a very good teacher, which I think will serve him well in the Navy."

Pitts said he didn't fully understand Holland's decision to join the Navy, but he said Holland had mentioned several times that he wanted to serve in some way.

And the experience Holland gains in the Navy, Pitts said, will serve him well on the staff of any hospital or university if he should decide to go back to civilian life.

"This is not a backward step," Pitts said.

The only real issue, he said, concerns academia. In a university setting, doctors conduct research and write about it. Holland might not do much of that in the Navy, he said, which might put him slightly behind other doctors at teaching hospitals. But, he said, Holland's vast experience and technical knowledge will be in demand today, three years from now and forever.

Holland took a pay cut of more than 50 percent to join the Navy, but he brushes aside the topic with a wave of his hand.

"The pay isn't as good as it would be in private practice, but that's not the point," he said. "Obviously, I didn't do it for the money. I didn't get into medicine for the money. Otherwise I'd be in private practice.

"I would hate to think I got into medicine for something other than to practice medicine. Of course, I'd rather be paid $10 million, I have no problem with that.

"But at the same time, I can look at myself in the mirror and just feel good that I'm doing things for the right reason."

E-mail John Koopman at jkoopman@sfchronicle.com.

Ellie