It is a path that has been traveled in an unbroken tradition for almost a thousand years. During parts of the crusades, when travel to Jerusalem was impossible for Europeans, Santiago de Compostela became the one of the major Christian pilgrimage sites in the world.

The trip ends at a small city in northwestern Spain, in a majestic cathedral that many believe houses the relics of Saint James.

An elaborate marble entryway called the Pórtico da Gloria flanks the heavy doors of the cathedral. Five holes are bored into its stone, which has been worn down through hundreds of years, by thousands upon thousands of human hands; hands of pilgrims that touched the marble column at the end of a long and arduous journey.

Three days’ walk from the cathedral lies the peninsular town of Finisterre, a Celtic holy site even more ancient.The peninsula juts out into space over the impossible expanse of the Atlantic Ocean. Though all that is left of the holy site itself is a single lighthouse, you can understand why people in ancient times believed it was the very end of the world.

In the middle of my second year of pediatric residency I walked this ancient pilgrimage route. I walked until sunset day after day after day. I put my tired feet in the waters of countless sacred springs. I visited an ancient hermitage bored into stone as shelter from the wind. I met pilgrims from around the world and felt connected to every one of them.

Then I got on a plane, flew halfway around the globe, and did an overnight shift in the Intermediate Care Unit at the Children’s Hospital. I held down a screaming boy with Down syndrome while the attending threaded a catheter into his neck. I watched a young mother faced with the heartbreaking decision of whether to extubate her baby, resuscitated at daycare from SIDS. I started tube feeds on an anorexic patient who hated me for it. I counseled an evangelical teen rape victim who refused emergency contraception. I tried to meet these strangers with care and connection, but often I felt lonely and afraid.

At times I wondered how these two realities could exist in the same world. How was it that this great work of the Lord could be home both to the setting sun at the lighthouse at Finisterre, and to the daily suffering of the Children’s Hospital? What possible connection could there be between an ancient pilgrimage route and a hospital?

But there is a poignant connection between pilgrims and hospitals.

Though the tradition of hospitality predates the written word, the first hospitals emerged during the Roman Empire. They were started by early Christians as monastic institutions designed to care for sick strangers. Early hospitals were sometimes called xenodochia because they were places that cared for sick foreigners. During this period, sick people were typically cared for in their homes by family members. Physicians would visit them there. This meant that travelers or foreigners without families who became sick would often be completely destitute. They were at the mercy of the street, the weather, and strangers.

The first hospitals were designed to care for these sick strangers, hence their name, hospitalia, which comes from the Latin word hospes meaning “stranger or foreigner.”

The xenodochia and hospitalia were often places that cared for pilgrims. Some historians argue that the great era of pilgrimage in the Byzantine period would not have been possible without the simultaneous spread of the hospital, that is, without places where people would care, not just for family members, or friends, or even neighbors, but for complete strangers.

Hospes is also the root of hospitality, the English word for the special relationship between guest and host. Much like the relationship between patient and healer, in many religious traditions it is regarded as sacred, with laws and strong mores on the treatment of visitors.

Hindu scripture instructs that the guest should be treated as a God. At the Golden Temple, the holiest site in Sikhism, people of every faith tradition are invited to stay for free where a massive kitchen feeds thousands vegetarian food only so that Muslims, Hindus, and Sikhs, each with very different dietary restrictions, can eat side by side. In Islam, the hospitality relationship forms a sacred triad that includes the guest, the host, and God. Hospitality is seen as an obligation rather than a gift, and the duty to provide it is a duty to God. The Celts, who populated northern Iberia where Finisterre is located, paid special attention to the importance of protection in hospitality. A host was expected to provide not only food and shelter to a guest, but also safety.

Jewish law takes this injunction even a step further, mandating that guests be provided not only with physical provisions and protection, but also that they be treated with love. In nomadic Jewish tribal custom, which arose in the harsh desert climate of the Iron Age, a host was expected to greet a guest outside, and provide water, food, and any other physical necessities before even asking the person’s name, where he came from, or what he was doing. 

One doesn’t have to be religious to realize the importance of hospitality, particularly in unforgiving climates. Vestiges of this primal moral impulse to provide shelter to strangers can be seen today in places like rural Alaska, where summer cabins are often left unlocked and fully supplied in the winter with the understanding that this practice might prevent a death by exposure.

At least one strain of this hospitality is enshrined in modern American law. EMTALA, the Emergency Medical Treatment and Labor Act is the federal law that mandates immediate stabilization for anyone coming to an emergency room with any condition that threatens life or limb, without regard to who you are, where you come from, or whether or not you can pay.

It’s not necessarily natural to want to care for strangers. In fact, that Latin word hospes comes from the same root as the Latin word hostis, from which we derive the English words hostility and hostile. Groups I just described as highly valuing hospitality to strangers were also commonly at war. The pilgrimage to Santiago rose to prominence after the Reconquista of Spain and iconography of the saint sometimes depicts him as “Santiago Matamoros,” Saint James the Moor killer.

Both of these cultures placed a high value on hospitality, but each also knew that strangers could be dangerous. How does one decide whether the stranger should be treated as an enemy or a guest?

There is something truly transformative about illness, something so powerful it makes special moral demands of us. Infirmity can turn a stranger into a guest – or even, as in the parable of the Good Samaritan, from an enemy into a neighbor. This transformation required, as Martin Luther King Jr. puts it, a “dangerous unselfishness” on the part of the Samaritan who helped the injured Jew move from a relationship of hostility to one of hospitality. Considering what must have moved him to do that, King says:

The Jericho road is a dangerous road, … In the days of Jesus it came to be known as the “Bloody Pass.” … And so the first question that the priest asked – the first question that the Levite asked was, “If I stop to help this man, what will happen to me?” But then the Good Samaritan … reversed the question: “If I do not stop to help this man, what will happen to him?”

The transformative power of illness lies in the recognition that our vulnerability is mutual. Each of us, if we live long enough, will spend time in what Susan Sontag calls “the kingdom of the sick.” She wrote of her experience with cancer:

Illness is the night-side of life, a more onerous citizenship. Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.

The truth is we are only pilgrims in the land of the well, or even of the living. Rumi writes: “This, being human, is a guesthouse.” Ultimately, each of us will die. And so our mutual existence as “strangers and pilgrims on the earth,” demands some kind of sacred hospitality.

And when we strip away everything else, hospitality is the essential function of the hospital.

True, a hospital is a place of healing, a place where the marvels of modern science can be applied directly to the human body, to cure disease, and where that is not possible, to alleviate suffering. But it is also a place where the sick can come to be cared for.

They come to us as strangers, and through their suffering, they become our guests. 

It is a great vulnerability. It too, is part of the “dangerous unselfishness” that King urges us to cultivate. But it is also a great privilege. The care of the sick stranger is a sacred calling.

And so it was with the Children’s Hospital. It was difficult. We saw suffering, and we held it in our hands, felt its weight, its heat, tried to make some meaning out of it. We bore witness to great struggles. There were moments when we stood uncomfortably outside rooms where the children we cared for were dying, and didn’t know what to do. There were times of great isolation, where we tried to breathe for children who couldn’t breathe. Sometimes it worked, and sometimes it didn’t. Day after day, we looked deeply into the eyes of other real, live human beings and told them things that were the worst things they could possibly imagine, and then told them things that were even worse.

And then there were times when we sat, all night long, at the bedside of a child on the brink of death, and two days later she was sitting up, complaining to us about a small tummy ache, and telling us she had no idea who we were. Times when we felt, suddenly, a deep sense of purpose, looking level into the eyes of a small sick child, or her mother’s or her father’s, and saying something as simple as, “I’m so sorry,” or, “She knows how much you love her,” or just, “I’m here.” And still there were nights when we felt so far from our original calling that we thought about quitting altogether. But we didn’t.

We weren’t the first group of people to experience this, and we won’t be the last. There are so many people who have walked this road before us. We are part of a great tradition that goes back millennia. There have been thousands upon thousands of us who have traveled this same Way.

Each one of us put our hands on something hard, and little by little each of us changed it. So that over time, it bore the imprint, not just of one of our hands, but of all our hands. Hands that together share the privilege of being healers, the hands of those of us who learned our work in hospitals. Those of us who are called to care for pilgrims. Those of us who are pilgrims.