Hiking through town. (Click to enlarge.)
The year before my hike, I was extremely busy with various ACR workforce issues; meetings; presentations, locally, regionally and nationally; juggling medical missions and more. However, I had blocked time in my calendar over one year in advance to hike the Camino de Santiago in Spain with a long-time U.S. Army buddy. I met Pat in 1988. We served together in internal medicine at the 98th General Hospital in Nuremberg, Germany, from 1988–90. Pat pursued a fellowship in pulmonary and critical care medicine, and had a successful career in Houston. Training for this journey, the actual experience and continual reflection after our hike enhanced my understanding of the inherent need for contemplative leisure.
Pat is an avid hiker. His exploits include hiking the Himalayas. In 2022, out of mere curiosity, I asked him about hiking Camino de Santiago, along the north coast of Spain. His response was “Hey dude, this is on my bucket list. Let’s do it together.”
I had never seriously hiked anywhere before, and I asked how much of the Camino we should hike.
“The entire route,” he replied, “500 miles over five weeks.” I humbly accepted his challenge. As a novice, I hoped I would be a quick learner. Hiking in the Pyrenees mountains, with a gain and loss of 3,000 feet a few times per day, for 35 consecutive days would be demanding.
Coastal view. (Click to enlarge.)
There are three primary hiking routes to Santiago de Compostela in Galicia, Spain: The most popular route is the Camino Frances, starting in the French Pyrenees; the Camino Portugues, from Lisbon to Santiago; and the Camino del Norte, adjacent to the coast from Irun to Santiago. Only 5% of hikers walk the north route because it’s the most physically demanding. However, it is the most picturesque route, bordered by the Bay of Biscay on the right and the Pyrenees on the left when hiking toward Santiago. The north route originated from James the apostle’s route in A.D. 40 followed by numerous historic battles for centuries in the Basque, Cantabria, Asturias and Galicia regions of Spain. Like the Appalachian and the Pacific Crest trails, which provide solitude and wilderness, the Camino also provides international camaraderie, European history, and unique cultures. Ultimately, most hikers celebrate their treks after arrival in Santiago de Compostela.
Preparation
Author and Pat. (Click to enlarge.)
Discovering state-of-the-art hiking gear was invigorating, and purchasing gear proved far easier than finding an effective internet training program for the hike. San Antonio is only 650 feet above sea level, but I discovered challenging hiking trails in the Texas Hill Country, only 15 miles from home, which nearly simulated hiking the Pyrenees. Progressive training for a minimum of 16 weeks was recommended, with a mix of short and long hikes and dedicated strengthening, so I respectfully started training 24 weeks in advance.
After eight weeks of increasing distances alone and simulating hikes, I developed limiting lumbar pain and metatarsal phalangeal (MTP) swelling. Panic and distress are inadequate words to describe my significant setback at distances of only 11 miles. My anxiety regarding the need to be fit for Camino was overwhelming; I self-referred to a doctor of physical therapy (DPT) for an assessment.
My DPT gently told me that I was not conditioning adequately for uneven and mountainous terrains in Spain. My role as a PT patient was undeniably fruitful. I followed a plan with two months of supervised strengthening of core, pelvic stability muscles and intrinsic muscles of the feet. I also had to abandon heavier hiking shoes for lighter and larger-sized trail shoes, with a wider toe box, for better performance.
Hillside pasture. (Click to enlarge.)
An unexpected benefit of the prolonged training time spent alone for hours was an unconsciously created mental space for me away from the hectic universe where my mind could wander almost aimlessly. It was weirdly refreshing, establishing a physical rhythm, in solitude, homing in and out of various thoughts and adventures in my mind without podcasts or music. After watching Emilio Estevez’s 2010 film The Way, starring Martin Sheen, a couple of times and reading Paulo Coelho’s book, The Pilgrimage, I was finally feeling on target for the Camino hike.1,2
Our logistics were organized by Camino Ways—a travel company for Camino hikes that coordinated our flights, lodging in B&Bs and small hotels, with daily breakfast and luggage transfer each morning to our next destination.
We flew into San Sebastian, a beautiful city on the north coast of Spain, not far from the French border and had a wonderful dinner. We were very excited, but apprehensive knowing our first week in the Basque region would demand 20-mile daily hikes in the Pyrenees.
Getting into a Rhythm
Cathedral. (Click to enlarge.)
The following morning, we began our five-week trek in the pouring rain, hiking upward into the mountains. Fortunately, by noon the rain had stopped on a mountain ridge, and donkeys welcomed us along a vineyard.
I only used my cell phone for photographs, videos or occasional texting with family; social media was off limits for my hike. Although we established a hiking rhythm after a couple days, we struggled with a viral syndrome and developed blisters on our toes from the steep mountain descents. Our AllTrails app, snacking, double espresso, stretching, analgesics, moleskin for blisters and red wine with dinner became part of our rituals for the next five weeks.
All hikers on Camino are endearingly referred to as peregrinos, or pilgrims, on their journey. According to Merriam-Webster, a pilgrim is someone who travels to foreign lands on a journey. Most pilgrims we met were hiking for the physical challenge, for a significant break from routines, for consolation, for soul searching or for a combination of those things. All pilgrims shared the trail with enthusiasm during short overlapping distances on the hike, with a recognition of each other’s country, and intimate chats—mostly in anonymity, not sharing names or occupations. The cultural greeting was “Buen Camino,” meaning good path or good road.
We were all there for intersecting reasons, with some commonality; everyone on the trail was uniquely trusting of each other. Many women and men of all ages hiked alone, seemingly without any concern for safety. Most stayed at albergues or hostels. Hikers from Australia, Ireland, Italy, Korea, Israel, Ukraine and other countries shared miles, snacks, chats and solitude. How surreal to be intimate yet anonymous, soulful without proselytizing, all ages yet ageless, patient and resilient, on a mission but mission-less. There was nothing pretentious about hiking the Camino.
Physical, Mental, Spiritual
I considered my first two weeks a purely physical phase of the hike. We were finally seasoned hikers with a daily rhythm, resilient with healed blisters and unflappable to any physical challenges. The invigorating scenery on foot was endless from beautiful beaches to rocky coastlines, from pastures and farmland with charming animals to remote trails and vast woodlands, through quaint towns into larger cities and from small hermitages along the way to city-sized cathedrals. I was physically in a groove.
The second phase was a mental transition in which I let go of any preoccupation for physical concerns and was altogether mentally relaxed. I shifted from mental anxiousness to pure mental clarity without distractions. The stimulating culture, seafood, street art, architecture, museums and simple daily events were heartily appreciated. Although I was on the trail with other pilgrims, I surprisingly discovered personal solitude for many hours each day hiking alone. For the last 10 days of my hike, I entered a profound transition to being one with nature and fully present in the moment.
This one with nature phase was an epiphany for me; I had never felt this way in my entire adult or professional life. My mind was so refreshed; I was feeling invincible and intellectually unbounded. My perception was totally opposite to any negative attributes of fatigue, stress, burnout, moral injury or soul loss. I had unconsciously transformed all dimensions of being fully human to a normal state: caring for the body, for emotion, for mind, for heart, for creativity, for the spirit and more.3
I remember when I was an undergraduate, professors left for sabbaticals to exercise intellectual work or intellectual contemplation for creative thinking. Today, healthcare providers are rarely eligible for sabbatical time for mental restoration or mental creativity. Josef Pieper references both Aristotle and Aquinas, who believed that intellectual contemplation was critical for human activity and important for human well-being.4
In our culture, physicians are mostly relegated to the tasks of non-intellectual work, but they intrinsically need time away from the workplace for intellectual work by themselves, but also to be part of their community.
In today’s chaotic environment, we all struggle to find solitude and time for self-care. How can we learn to be present in the moment only? How can we leave recent tasks behind and not focus on imminent future responsibilities? How can we dedicate time to solitude for rest or for intellectual contemplation? This is not taught in school or residency or as staff. This requires insight, discipline and a commitment to simply manage our distractions and focus on the true priorities of the moment.
Victor Frankl said: “When we are no longer able to change a situation, we are challenged to change ourselves.”5
Climbing mountains (or similar professional metaphors) can be transformative in the moment, providing a great vision at the pinnacle, looking both backward and forward. Our challenges do not need to be like Sisyphus’ if we can somehow better define our priorities; not all our ideal wants or needs are true priorities.
Hiking in solitary space or creating alone time for extended periods enables mental rest, contemplation, creativity, perspective and can help prevent burnout. Sometimes, just being present is better than doing; sometimes our heart is more important than our mind, and sometimes being mentally grounded, without worrying, even in the presence of others, can be self-preserving.
On Arrival
On arrival in Santiago de Compostela Plaza, we were welcomed with melodious bagpipes sharing the Celtic influence on Galicia. I was standing in the square with innumerable pilgrims cheering, taking selfies, singing and laying down. I had an overwhelming sensation of contentment, peace and gratitude. This was an ineffable experience. Buen Camino.
Daniel F. Battafarano, DO, MACP, MACR, is an adjoint professor of medicine at the University of Texas Health and the University of the Incarnate Word College of Osteopathic Medicine, both in San Antonio, and a professor of medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md. He retired from the U.S. Army Medical Corps as a colonel.
References
- Estevez E (director). The Way. Filmax. 2010 Nov 19.
- Coelho P. The Pilgrimage. San Francisco: HarperOne. 2021 Aug 3.
- Kopacz D. Caring for Self & Others: Transforming Burnout, Compassion Fatigue, and Soul Loss. Palisade, Colo.: Creative Courage Press. 2024 Jun 25.
- Pieper J. Leisure: The Basis of Culture. San Francisco: Ignatius Press. 2009 Oct 1.
- Frankl VE. Man’s Search for Meaning. Boston: Beacon Press. 2006; p. 113.
