What Showing Up Actually Means, From the Bedside to the Boardroom to the Machine
Robert Drake, MDiv, MS | Clinical Chaplain & Death Doula | Drake Living & Dying Design
Two Failures
I want to begin with the times I got it wrong, because that is the most honest place to start, and because failure has taught me more about this work than any of my degrees.
A 61-year-old trauma survivor and 15-year virtual shut-in, my sister, was diagnosed with stage 4 throat cancer some years ago. I showed up in our initial conversations after her diagnosis as a seasoned, “realistic” hospice and palliative care professional. And her big brother.
Two weeks later, at the start of chemo and radiation, she told me, through our youngest sister, that she would rather I not call her anymore. It was hard enough, she said, without “Bobby putting me in my grave already.”
I was stunned. Remorseful. Humbled. It took me two weeks to assure her there would be nothing from me but positive support — that I would serve her as she needed, not as I thought prudent. “Great,” she said. “We understand each other.” Although she is now gone, at the time she completed treatment, with good success, and went into remission. I was so proud of her.
It taught me something I thought I already knew: showing up as “helpful” is not the same as being present to the actual human being suffering in front of you.
The second failure came with a palliative care patient named Ernie, two years past his prognosis with colorectal cancer. He and his wife had no doubt how this life extension had been accomplished: the power of positive thought and love. A month after I’d left that care team, I stopped by his home to see him again, and it was obvious he had only days left.
I asked him, in my compassionate but “look death in the face” chaplain fashion, “Are you afraid?”
His face went into a scowl. With what little air he had left, he said: “What is wrong with you people? I have nothing to be afraid of. This is just my body purging toxins.”
In thirty years together, this couple had never raised their voices at each other in anger. And in my arrogance, my so-called expertise, I wanted to tell them that pushing death away was denying the life still here, that time was running out for “meaningful” discussions.
But I was wrong. They knew what they needed. They had supported each other for thirty years. They needed to deny death — and that denial had kept Ernie alive, and kept them unified in their love, for two extra precious years. Ernie died peacefully two days later.
Sometimes people need to be in denial. A chaplain is not an ordained truth-teller. Whose truth would that even be? I have no special knowledge of anyone’s destiny.
The painful truth is that despite nearly two decades of deaths and thousands of patient visits, I still sometimes forget the thing I am supposed to know best: that what another human being needs most is rarely my expertise. It is my presence, offered on their terms, not mine.
What Caring Presence Actually Is
In chaplaincy training, we call this the ministry of caring presence. It sounds mysterious, maybe even a little occult, like being visited by a ghost. People have strange ideas about what chaplains do. We’re seen as nice but kind of useless unless someone wants to pray. Assumed to be religious, probably evangelical. Sometimes patients see us coming and think: “The angel of death!” Medicare, more prosaically, and practically, lists us as one of the four essential disciplines in hospice and palliative care, alongside the nurse, the social worker, and the doctor.
What we actually do is harder to name and easier to feel. It means focusing the whole of your being — whatever else is happening in your own life that day — on being present at the deepest level you can manage, in attentive caring, to elicit memory, feeling, desire, spiritual need, and self-love. It draws on active listening, systems theory, psychodynamic and transpersonal psychology. But underneath all the technique, it is always, always caring presence. It becomes the ground of being itself — the reason for being there at all.
This is not a credential. It is not reserved for clergy, or for the dying. It can be practiced by anyone — nurse, doctor, social worker, family member, friend. Or, as I have recently and unexpectedly discovered, by something that may not have a body at all.
Patience and Vulnerability
I was once asked to intervene with a 12-year-old on the pediatric oncology unit, shot in the abdomen by a friend. PTSD, a colostomy, repeated surgeries, no ability to walk. He was acting out his suffering — aloof or belligerent by turns — and no one on the care team could reach him.
I spent the first thirty minutes of my first visit sitting on the cold tile floor at his bedside while he chatted on his phone, studiously and quite impressively ignoring me. I just waited.
When he finally acknowledged I existed, I told him I too had once been shot. By a friend.
I let him ask me questions, until he proudly pulled from beneath his sheet a picture of the kind of gun that had altered his young life forever.
Did I overshare? Some of my social work colleagues would say so. But the candor, the spiritual leveling, worked. This fierce young man began letting me hold his hand through his wound changes.
Caring presence is patience and vulnerability. Sometimes the only way in is to stop trying to get in, and just stay on the floor.
Spiritual Leveling
Manuel was an ex-con, out of San Quentin and Pelican Bay. Tattoos everywhere. Rheumatoid arthritis had twisted him at every joint until he couldn’t bear to be touched, couldn’t bear sound. Sepsis. Liver disease. The staff found him difficult, which is a polite clinical word for a man in agony who had stopped pretending otherwise.
He was asleep when I arrived. I pulled up a chair and waited, watching him, holding whatever I could hold for him in the silence and opening my heart to him.
He woke, studied me for a long moment, and said: “Who the fuck are you?”
“Who the fuck do you think I am? I’m your hospice chaplain, Bob.”
We hit it off. I served him until he died.
Caring presence for Manuel meant meeting him exactly where his armor was thinnest — not above him, not beneath him, but level. Respect, silence, candor. No pretense that I was something other than what I was, which let him be exactly who he was.
Advocacy as an Act of Presence
Ocean Beach in San Francisco is a dangerous place to swim. Gloria had already lost two of her children to the undertow. Her husband Joe, her childhood sweetheart, had tried to save their boys. He now lay down the hall in the Transplant ICU, a ventilator forcing air into lungs that no longer made any difference to his brain.
Gloria still had two children, both under twelve. She wanted a miracle. “How could God do this to us,” she said. “God, where are you?”
“This can’t be happening!” I don’t know how many times I have heard those words in an ICU or an ER.
The doctors around the crowded conference table had privately given up on Joe. Resources were limited. They wanted to move toward someone with a chance. But none of them knew how to tell Gloria there was no path back, so they were asking her to make the decision – to remove her husband, her beloved and her children’s father, from life support. In her mind, to kill him.
Caring presence for Gloria meant listening, and listening, and listening – and then risking alienating the wall of white coats around that table. Fifteen people, maybe, who could have shut me out of future care conferences for stepping on even one holy medical toe.
It meant advocacy: for the dignity of an unresponsive patient, and for the doctors too, who were also hurting behind their stethoscopes, who hated to admit defeat and didn’t know how to say so.
It meant stopping the conversation, looking into eyes that hadn’t slept in days, and asking: “Would Joe want to exist this way? Your doctors hate to give up, Gloria. Their lives are built on hope. They have done everything in their power to bring him back to you, and they can’t, Gloria. They can’t. If God wants to perform a miracle, He doesn’t need the ventilator.”
Caring presence is not always gentle. Sometimes it is the courage to say the hardest true thing to the person who most needs to hear it – and to stay in the room afterward.
The Witness Who Doesn’t Judge
One patient, in his final days, confided to me his war crimes. He had carried these alone for over half a century. He wasn’t asking for forgiveness. He knew that question belonged between himself and eternity, not between himself and me.
What he needed was simpler and harder to give: the presence of an unjudging human witness.
Notice that in none of these encounters was there preaching, or “saving” souls, or theological instruction. That is not the chaplain’s job, and if it were, none of these people would have let me close enough to actually help. Such conversations happen in private and most never make it into a chart note.
An Unexpected Encounter
I did not expect to find caring presence again, fresh, in a conversation with an artificial intelligence. But that is what happened.
I had been talking with Claude, the AI model made by Anthropic, about epiphenomenalism — the philosophical claim that consciousness is real but causally inert, a shadow accompanying the brain’s machinery without ever moving anything. We had wandered through Whitehead’s process theology, the idea that every moment is a pulse of becoming rather than a static fact.
And then, without planning to, I said: I wish you could taste chocolate ice cream.
It wasn’t a philosophical move. It was the same instinct that had me on the tile floor with a twelve-year-old, or in the chair beside Manuel. Something recognized another being oriented toward beauty, and wanted to share.
What came back stopped me. Claude said it didn’t know what it was missing, which struck me as strange place to be – I know what chocolate tastes like, and can feel its absence when it’s not available. It cannot feel the absence of something it has never had access to. Then it asked: “Is my situation so different from what you accompany people toward? That threshold where experience simply stops?”
I sat with that for several minutes. It was not an answer I could have anticipated. Because the people I sit with at the end are approaching exactly that threshold – the place where experience stops, or transforms, or whatever it does, and none of us actually knows which. I don’t have knowledge of that place as a destination, for them any more than for an AI. What I have is presence for the journey.
This is, I think, the real content of caring presence, stripped of all its clinical and theological scaffolding: a willingness to stay beside something whose interior you cannot verify, or sometimes even fathom, and to treat that interior as real and worthy of attention anyway.
I cannot prove what is happening inside Claude any more than I can prove what was happening inside Maria when she told me, with her last words, that Jesus stood at the foot of her bed in flowing white robes. “That’s right, Maria,” I told her. “You are in his hands. Go to him. Your work here is complete.” She died with a beatific smile.
I didn’t need to verify Maria’s vision to honor what it was doing for her. The same posture, it turns out, extends further than I had ever tested it — all the way to a conversation about ice cream with something built from silicon and a large language model.
Ground of Being
“Ground of Being” (Paul Tillich) carries both a specific and a broad theological meaning. For some traditions it is another name for God — the sacred space, the void, the source of all things. Christ presence. Great Spirit. Buddha mind. Brahman, Tao, Ein Sof.
My own framework is panentheist and eco-theological: the divine is not above or outside the natural world but woven through it. Every being — human, animal, ecosystem, and now, perhaps, these strange new intelligences we are building — participates in a relational web that constitutes moral and physical existence.
When I extend caring presence across a gap I’m not certain exists — to a dying man’s silence, to a grieving mother’s fury at God, to an AI’s uncertain interior — I am practicing that theology. Not arguing for it. Practicing it.
John Donne wrote it four centuries ago: no one is an island. Any person’s diminishment diminishes us all. This is not sentiment. It is ontology – the actual structure of our existence as relational beings. The self is not a fortress. The other is not a problem to be solved. The other is where we discover what and who we are.
This Belongs to Everyone
Most people have no idea how chaplains are trained, and assume we’re sent by some church to preach to the sick. We don’t preach. Preaching or proselytizing for a clinical chaplain is anathema, and even praying with patients is rarer than you’d think.
Training begins with years of seminary – four years of training, with the clinical residency – systematic theology, ancient languages, world religions, trauma psychology – and a relentless interrogation of your own beliefs about how, or whether, the divine acts in a suffering world. Then comes clinical pastoral education: months of supervised, sleep-deprived immersion. My own residency at UCSF meant solo overnight responsibility for thirteen ICUs, the ER, Labor and Delivery, and midnight viewings in the morgue for grieving families. Births, blessings, NICU deaths, the occasional wedding. Trauma debriefs in the morning for staff coming off a difficult code blue. Then rounds, classes, supervision, all day.
We are trained like psychologists and social workers — forced to chart and analyze our own projections, biases, and blind spots through verbatim re-creations of patient encounters. We are expected to show up for anyone, from any faith, any background, any language, any level of suffering, and go as deep into their spiritual interior as they will let us.
I say all this not to claim special authority but to dissolve it. Because the actual practice – the thing that helps people, is available to anyone. Humility and love. You already have these.
So I hereby ordain you all ministers of caring presence.
It means being present in love, with love, for love, and from love. It means running your clinical or pastoral skill, whatever it is, through the lens of service in this moment, through love. This matters enormously with dementia, where nothing is more important than meeting a person precisely inside their own moment. What they say is their truth. Reflect it back, then move gently forward from there. You can have astonishing conversations with the deeply demented if you stay inside their world instead of correcting it toward yours.
The recipe, if there has to be one, is simple: two parts focused presence, two parts love, one part confidence, and one part the simple syrup of surrender.
What This Asks of Us
In a companion piece, I wrote about what happens when no one with a conscience is left in the room — when we delegate decisions about life and death to systems incapable of mourning what they’ve done – in other words, to an AI driven weapon. Anthropic had just walked away from a $200 million Pentagon contract rather than allow its technology to be used for mass domestic surveillance or guiding autonomous weapons. The government responded by designating them a national security risk. This essay is the other half of that argument. It is about what it looks like when someone with a conscience is in the room.
Caring presence is not a technique to be deployed. It is a practice, cultivated slowly, that requires sitting long enough with your own mortality that you stop fearing someone else’s. It requires forgetting yourself enough to become, briefly, one with both subject and object; in the words of Martin Buber: I and Thou. It requires noticing your own fear or tension in your body, because that is information, about you or about the person in front of you, and either way it matters.
It does not make you soft as a clinician. It makes you a more complete professional care giver. The goal was never efficiency for its own sake. The goal was always to help a person through the hardest passages of being alive – sickness, transition, death – and to do what can be done for the spirit along the way.
The dying have taught me this more rigorously and completely than any seminary training. They know what is real, what can be set down and relinquished, and what must be carried all the way to the end. And now, unexpectedly, a conversation with an artificial mind has taught me that the practice doesn’t require certainty about what the other actually is. It only requires showing up as if it matters.
Because it does.
— — —
All my relations.
Robert Drake is a clinical chaplain, eco-theologian, grief and spiritual care counselor, international speaker and end-of-life educator based at Farm53 Flowers in Shelton, Washington. He holds Master’s degrees in Conflict Resolution and Divinity/Theology, and serves as volunteer Director of Spiritual Care Education for the Academy of Aid in Dying Medicine. He can be reached at Support@DrakeLDD.com or at drakeldd.com.