by Robert Drake | Jun 22, 2026 | Uncategorized
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.
by Robert Drake | May 26, 2026 | Uncategorized
“To forgive is to set a prisoner free and discover that the prisoner was you.” — Lewis B. Smedes
I have a question I’ve been asking patients and their families for years, and the response never changes. I posed this question to a clinical audience of physicians, nurses, social workers and chaplains at the City of Hope International End of Life Symposium a couple of years back: “Show of hands: how many of you were told, at some point in your life, that you ought to forgive, that you ought to be forgiving? Nearly every hand goes up. Now: how many of you were taught how to forgive?” No hands came up.
That gap is telling and truly significant, and in my clinical and personal experience, one of the primary sources of unresolved suffering at the end of life. We assign forgiveness as a moral obligation, particularly in religious contexts, without ever providing instruction, without acknowledging that it is a skill, a practice, something that requires development over time the way any other capacity requires practice. All of us were told when young, and throughout life really: you need to forgive and move on. We tell people what they should do and leave them entirely alone with the how. Then we wonder why so many people arrive at their deathbeds still carrying what they’ve carried for decades.
I want to talk about what forgiveness actually is, what it isn’t, why self-forgiveness is maybe the best place to start, and how to begin practicing it before it becomes urgent.
Forgiveness is, and must be, a freely made choice to give up revenge, resentment, and harsh judgment toward a person who caused a hurt, and to strive instead toward compassion and generosity. That definition comes from the research of Enright, Freedman, and Rique, and it’s useful precisely because it is centered in, and requires, personal choice. Forgiveness is not something that happens to you. It is not a feeling that arrives when the conditions are right. It is an act of will, undertaken for your own sake.
Mark Twain said anger is an acid that does more harm to the vessel in which it is stored than to anything on which it is poured. Nelson Mandela said resentment is like drinking poison and hoping it kills your enemies. Both are pointing at the same clinical reality: unprocessed guilt, shame, and anger live in the body. They shape the quality of our lives and, when we run out of time to address them, they shape the quality of our deaths.
I have been at a great many trauma, illness and death-bedsides. Too many to count. I have witnessed reconciliation arrive in the final hours of a life and watched someone die with a perceptible release, the people around them changed by what just happened. I have also witnessed the other kind of death, the one weighted by things unsaid and unresolved, and I can tell you that the suffering that follows that death can endure for years in the people who survive it. What happens at the end of life is not only about the person dying. It radiates outward and onward.
The research supports this. A large meta-analysis published in 2015 found strong correlations between self-forgiveness and psychological well-being, and moderate correlations with physical health, across nearly eighteen thousand participants. This is not just qualitative territory. Forgiveness has measurable clinical, real-life consequences.
Before I go further, let me say clearly what forgiveness is not. It is not a single event. It is not condoning or justifying what was done to you. It does not require you to seek out or speak to the person who harmed you. And it cannot be done for someone else. Simon Wiesenthal’s book The Sunflower, which asks whether he should have forgiven a dying Nazi soldier for crimes committed against Jewish people, elicited responses from philosophers, theologians, ethicists, and survivors. The most consistent finding was that one can only forgive wrongs done to oneself. You cannot forgive on behalf of others, and no one can forgive on your behalf. And no one ought to tell another that he or she should forgive.
Which brings me to the piece that gets underemphasized: self-forgiveness probably has to come first. Not because we have wronged others more, but because it is the closest place to start the practice and often the hardest to do.
Maya Angelou said forgiveness is the greatest gift you can give yourself. It’s not for the other person. I think this is true, and I think most of us, especially those of us shaped by religious traditions that frame forgiveness as primarily something we extend to others, have the order wrong. The work begins inside. What stops us from forgiving ourselves? Usually some combination of guilt, shame, unexpressed grief, and a failure to recognize the cost of carrying all of it. Gandhi said it plainly: the weak can never forgive. Forgiveness is the attribute of the strong and if I can do it, it buttresses my own sense of strength.
The theologian Nadia Bolz-Weber once said that if we could capture shame as an energy source, it could replace fossil fuels. That’s not just a striking statement. It’s an accurate description of the mass of energy most of us have locked up in self-recrimination, shame over old failures, and accumulated regret. That energy can be redirected toward healing. Toward reconciliation. Toward what I’d call a more peaceful passage, both for the dying and for those who will grieve them.
So how do you actually do it?
I often use the American Buddhist teacher Jack Kornfield forgiveness meditation. This guides a person through practice of forgiveness for others, forgiveness for self, forgiveness of those who have hurt or harmed you. Remember, this is a practice, not a performance.
Dr. Martin Luther King Jr. said forgiveness is not an occasional act but a constant attitude. I’d add: start small. Choose minor failures, minor hurts. It is important to be extremely gentle with yourself when you do this. I recommend choosing something small to start with; like forgiving myself for not taking as good of care for my body as I could have. Or for not accomplishing all I wanted to with the day; or for losing my patience with my spouse for one thing or another. Practice and move on to something else, slowly choosing bigger incidents. Try choosing something another did to you or failed you in some small way and move on. If we can be forgiving of ourselves for small things, in time we can gain traction with the bigger stuff.
Build the muscle before you attempt the heavier lifts, the betrayed friendship, the disappointed child, the patient you couldn’t save, the family interaction that caused a rift that you could have managed better. The goal of the practice is not perfect outcomes. It is just getting better at the practice. You work at it, and over time the capacity grows.
Jack Kornfield describes the process as an easing of your own heart. We have all been harmed, just as we have all harmed others and ourselves. The forgiveness is fundamentally for your own sake, a way to gradually release the pain of the past and carry it no longer.
Forgiveness researchers describe a process with roughly four movements. The first is uncovering: getting honest about how the offense, whether against you or by you, has actually hurt and changed you, how much mental and emotional space it occupies. The second is decision: once you understand what not forgiving has cost you, you can choose to commit to the process. The third is work: developing empathy and compassion for yourself and, where applicable, for the one who caused harm. The fourth is deepening: finding some meaning in the suffering, recognizing that it connects you to a larger human experience rather than isolating you in a private one.
If you are a clinician, a physician, a doula, a social worker, a nurse: the people in your care are carrying this. Many of them are carrying it right to the edge. You don’t have to be a chaplain to ask about it, to create the opening, to refer to someone who can help. Starting earlier is always better than waiting until it becomes urgent because the hourglass of a life is nearly empty.
And if you are carrying something yourself, which most of us are: give yourself, as I sometimes say, a bolus of F vitamins. Start where you are. Start small. As the singer-poet Don Henley wrote, the heart of the matter, in the end, is forgiveness.
by Robert Drake | May 15, 2026 | Uncategorized
What a Chaplain Actually Is, and Why You Might Want One
by Robert Drake
If you grew up watching MAS*H, you have a chaplain in your head already. Father Mulcahy — gentle, earnest, slightly out of place among the surgeons and the chaos, offering prayer and last rites and a kind word in the dark. He is a good man. He is also not what most chaplains are, and perhaps not what you need when the world falls apart — unless, perhaps, you are Catholic.
Let me tell you what a chaplain more often is. I’ll start with two of my chaplaincy failures.
Some years ago my younger sister was diagnosed with stage four throat cancer. Two weeks after her diagnosis, at the beginning of chemo and radiation treatments, she told me — through our youngest sister — that she would rather I not call her anymore. It was, she said, hard enough for her without “Bobby putting me in my grave, already.”
I was stunned, remorseful, and humbled.
I had shown up as a seasoned hospice and palliative care professional. An expert. Her big brother who knew about these things. I had not shown up as someone present to what she actually needed.
It took me two weeks to assure her there would be nothing from me but support — that I would serve her as she needed, not as I thought prudent. She said: “Great. We understand each other.” She was treated, went into remission and for a few years more she survived.
Not long after, I had a palliative care patient with colorectal cancer who had survived two years beyond his prognosis. He and his wife had no doubts about how: “…the power of positive thought and love.” When I visited again and it was clear he had only days left, I asked him in my compassionate but “look death in the face” no-nonsense chaplain fashion: “Are you afraid?”
His face changed to a scowl. With his limited air and energy 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 to each other in anger. They needed to deny death. That denial had kept him alive and them unified in love for two extra precious years. He died peacefully two days later.
I was wrong. They knew what they needed. I had forgotten, in my expertise, to be present to them.
The painful truth is that in spite of my experience with so many deaths and thousands of patient visits, I sometimes forget what I am actually there for. I am not there to tell the truth as I see it. I am there to be present to the truth as they are living it.
I have been either training for or doing this work for nearly two decades. I have sat with the dying in hospice, skilled nursing, and assisted living, in ICUs and emergency rooms, in pediatric oncology wards where the patients are children and the grief and courage are both unspeakable. I have accompanied people choosing medical aid in dying — not escaping life, but refusing to endure intolerable terminal suffering at its end. I have worked in psychiatric forensic units with residents found not guilty by reason of insanity. I have sat in restorative justice circles at San Quentin prison with men serving life sentences where showing weakness is dangerous and hugging is punishable, accompanying them in their own long reckoning with the harm done and the humanity somehow retained.
I am also not very religious.
I am an interfaith chaplain, which means I am trained in the beliefs, practices, and sacred texts of many traditions — Christian, Jewish, Muslim, Buddhist, Hindu, and beyond. I can pray with you if you want prayer. I can sit shiva, honor Ramadan, or simply hold silence with you in whatever way your tradition, your condition, or your grief requires.
But what drives me is not religion. It is philosophy. I bought my first book in fourth grade — the Dialogues of Plato. I have carried it, in one form or another, ever since — Socrates and his unwavering dedication to truth and virtue, unafraid of death. Socrates said, “the trick, my friends, is not avoiding death but avoiding unrighteousness — for that runs faster than death.” I have the Delphic dictum know thyself tattooed in Greek on my arm, not as decoration but as guiding methodology. My early graduate work was in philosophy and conflict resolution, grounded in Kantian respect for persons — the radical, unconditional idea that every human being possesses inherent dignity, regardless of their beliefs, their diagnosis, their history, their position in life, or their condition.
That is what I bring into every room. Not a denomination. A commitment to your worth as a human being.
So what does a chaplain actually do?
The honest answer is: it depends on what you need.
A chaplain is trained to enter any situation — any prognosis, any diagnosis, any social or economic circumstance, any faith tradition or philosophical framework or absence of either — and be present for what that person and their family actually needs. Not what we think they need. Not what would make us comfortable. What they need.
That requires something more demanding than good intentions. It requires knowing yourself — your own beliefs, your own losses, your own background, your gender and race and history and the assumptions you carry because of all of it — well enough to serve rather than impose. A tall white man from a middle class background walks into a room carrying all of that whether he acknowledges it or not, and who he is generates a response from those he meets. I carry the fraught relationships with my dead parents, the experience of growing up in the Midwest. The training is in the acknowledgment. In knowing what you bring so it doesn’t arrive uninvited. This is why we usually do a supervised internship in a clinical setting for at least a year, being forced to do verbatim recreations of patient and family encounters — questioning everything we said and did.
This is why chaplaincy is not interchangeable with good nursing, or skilled therapy or social work, or a caring friend — though all of those matter enormously. A chaplain is specifically trained in the territory where medicine reaches its limits. Where the diagnosis is clear and the prognosis is terminal and the question is no longer what do we do but how do we be. Where the family is shattered and there is nothing to fix and someone needs to stay in the room anyway — vulnerable, feeling, present to the pain without running from it.
We are trained to stay. Without an agenda. Without needing it to resolve. What we strive for is reconciliation of suffering, of a life lived, of loss and of need, of broken dreams and relationships.
Manuel was an ex-con out of San Quentin and Pelican Bay prisons. He had tattoos everywhere. He also had rheumatoid arthritis so severely he was twisted in spine and every limb. He couldn’t bear to be touched. Even sound hurt. He had sepsis. He had liver disease. He was obnoxious to the staff because he was “difficult.”
Manuel was asleep when I arrived. I pulled up my chair quietly and I waited.
For a long time, I waited. I watched him and channeled love to his twisted body and psyche. He awoke and, opening his eyes, said — after a long silent assessment of me — “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.
Ministry of caring presence for Manuel? Spiritual leveling, respect, silence, candor.
Near the end of his life, one of my patients confided in me his treason and war crimes. He had carried this burden alone for over half a century. He wasn’t asking for forgiveness. He knew that was between himself and eternity. He needed only the presence of an unjudging human witness.
What he needed was simple caring, compassionate presence.
That is the work. Not preaching. Not saving souls. Not offering answers to questions that have no answers. Just — remaining. Present. Unjudging. Fully human alongside another human at the hardest moment of their life.
Chaplains are more diverse than most people know.
We serve in hospitals, hospices, prisons, military units, disaster response teams, university campuses, and corporate settings. We come from every faith tradition and some from none. There are Buddhist chaplains and humanist chaplains and chaplains who, like me, are better described as philosophers than believers — grounded not in doctrine but in the dignity and worth of every person who sits across from them.
What unites us is not theology. It is a commitment to compassionate presence. To accompaniment. To the belief — or the practice, which is sometimes more honest than belief — that no one should face the hardest moments of their life or their death alone, without someone trained to be there fully, without flinching, without an agenda, without needing them to be other than they are.
If you are facing a serious illness, or accompanying someone who is — call a chaplain. You do not need to be religious. You do not need to be spiritual. You do not need to believe anything in particular. You need what every human being needs at the edge of their life: someone genuinely present. Someone who will not look away. Neither trying to change you nor explain away what you are going through.
If you work in medicine or caregiving — consider what chaplaincy offers your patients and families that the rest of the care team, however skilled and however caring, is not specifically trained to provide. We are not an add-on. We are not the person you call when someone is actively dying and you don’t know what else to do. We are most useful when we arrive early, when there is still time to accompany rather than only to witness. There is good reason that Medicare requires hospice and palliative care teams to include a chaplain alongside the physician, nurse, and social worker.
And if you are considering this work as a vocation — know that it will ask of and utilize all of who you are. Every loss you have carried. Every room you have been afraid to enter. Every question you have sat with that did not resolve. It will ask you to know yourself honestly enough to be present for someone else without making their crisis about you.
It is, in my experience, among the most demanding and most meaningful work a human being can do.
Father Mulcahy was a good man doing his best in impossible circumstances. So are most chaplains, of whatever gender. But the best of us are not defined by our collar or our tradition or our institutional role. We are defined by our willingness to enter the room, to stay without flinching, and to accompany another human being through whatever they are facing — with full respect for who they are, what they believe, and what they need.
That is what a chaplain is.
That is why you might want one.
Robert Drake is a clinical interfaith chaplain, death doula, eco-theologian, mediator and end-of-life educator with nearly twenty years of experience in hospice, palliative care, psychiatric, pediatric oncology, emergency medicine and medical aid in dying. He serves as volunteer Director of Spiritual Care Education for the Academy of Aid in Dying Medicine and works with individuals and families throughout the Pacific Northwest through Drake Living & Dying Design for grief and loss coaching individually and in group retreats. He is the originator of The Death Soiree. He can be reached at Support@DrakeLDD.com. #grief #loss #endoflife #medicalaidindying #chaplaincy
by Robert Drake | May 5, 2026 | Uncategorized
On Dementia, Witness, and the Grief No One Names
by Robert Drake
There is a particular kind of grief that has no funeral.
No casseroles arrive. No one sends flowers. The person you are grieving is still alive — still breathing, still present in the room, sometimes still laughing at something only they can see. Sometimes crying for no apparent reason. Their hands are the same hands you have held for decades. Their face, in dim light, is still the face you have loved for decades.
But the witness you have loved and lived with for so long is gone.
— — —
In an earlier essay I wrote about what we lose when someone we love dies — that beyond the person themselves, we lose the witness they carried — a validating and authenticating partner in key memories. The one who remembered us young, who held the chapters of our life that no one else inhabited, who could say: “yes, that happened, I was there, I remember you then.” When that person dies, those chapters lose their only other custodian.
Dementia does something more disorienting still.
It takes the witness while leaving the body behind, still breathing.
— — —
I have sat with many families navigating dementia — in hospice, in palliative care, with friends, in the long middle years before hospice becomes relevant. What I observe, consistently, is a grief that is real, constant, and almost completely unsanctioned.
The person is still alive, so your grief is premature, right? So we feel that our grief should be managed, reframed, redirected toward gratitude for the time remaining. The caregiver who breaks down is gently reminded that their loved one is still here.
But that is precisely the problem. They are here. And the witness is not.
The spouse of fifty years sits across the table from someone who no longer remembers their wedding. The adult child visits a parent who no longer knows their name. I visit an old friend in the memory care unit and walk endless hallways, turning around at each barrier and just trying to be of some company — a reminder of what he surely must remember… right? The sibling speaks to someone who once shared their childhood bedroom and now inhabits a present moment with no past attached to it. The shared history — the decades of ordinary days that constituted a life together, that constituted your life as witnessed by this person — is gone from their side of the relationship.
You remember everything. They remember nothing, or fragments, triggered by a song, or a version of the past that no longer includes you in the way you actually existed together.
You are carrying the shared life alone. And they are sitting right there. Just sitting.
— — —
This is what I mean by the continuous presence of absence. It is not the clean break of death, which at least grants us permission to mourn. It is something relentless and without resolution — a grief that must be lived inside the ongoing relationship, a loss that cannot be named as loss because the person has not yet gone. Naming it as loss just doesn’t seem fair. But this is not fair.
Dementia caregivers are among the most isolated people I know. Not because they lack support — many have family, some have professional help — but because the grief they are living with does not have a name that others recognize. They are not yet bereaved. They are not yet widowed or orphaned. The social scripts for loss do not apply to them. And so they carry it alone, often for years, in the company of the very person they are grieving.
That is a particular kind of loneliness. It does not announce itself. It accumulates — daily, in small moments. The moment you reach for a shared memory and find that it is no longer shared. The moment you make a joke that once would have had you both in stitches falls into vacancy, into a vacuum — a void. The moment you realize that the person who knew you best, who held the longest record of who you have been across a lifetime, is no longer able to hold it.
You become, progressively, the last witness to your own shared history.
— — —
There is a clinical term — anticipatory grief — that captures some of this. You are grieving a death that has not yet happened, kind of mourning it forward. This is real, and it is well-documented, and it is still not adequately acknowledged in most caregiving contexts.
But the dementia experience extends beyond anticipatory grief into something I find harder to name. It is not only that you are grieving a future death — a future catastrophic loss. It is that you are experiencing, in the present, the loss of a relationship that has already ended in every meaningful way while the physical presence of the person continues.
I want to call this ontological loneliness — and I mean the word ontological precisely, not as decoration. In philosophical terms, ontology is the study of being — of what it means to exist, to be real, to be present in the world. Ontological loneliness is not the loneliness of circumstance, not the loneliness of an empty house or a silent phone. It is loneliness at the level of existence itself. A solitude that lives not in your calendar schedule or your social life but in the deep structure of your being — in the fact that you are present to someone who can no longer be fully present to you.
We are, at our core, relational creatures. We come into being in relationship — as relationship. We understand ourselves through being known by others. The philosopher Martin Buber spoke of the I-Thou relationship — the encounter between two full subjects, each genuinely present to the other, each capable of being changed by the meeting of hearts or minds. What dementia does, slowly and without mercy, is convert that I-Thou encounter into something closer to I-It. Not because the person with dementia becomes an object — they do not, they remain fully human, fully deserving of dignity and love, and you treat them with that dignity. But the reciprocity that makes genuine encounter possible — the capacity to be witnessed and to witness in return — has dissolved on one side, leaving you alone.
You are present to someone who cannot be fully present to you. You are known by someone who no longer knows you. You reach toward them and something reaches back, but it is no longer the same someone. The mutuality that once constituted the relationship — the shared thread that ran between two people across decades — is now held entirely by you. Sometimes you hold it with your fingertips, sometimes with the entire force of your love and will.
That is what I mean by ontological loneliness. It is not a feeling, exactly, though it produces feelings. It is a condition of being. A structural solitude that no amount of company or support fully addresses, because what is missing is not people — it is the specific person who made you real to yourself in a particular way, and the relationship that once allowed you to be genuinely known, felt, seen, understood, touched.
— — —
For those reading this from inside a dementia caregiving relationship: what you are experiencing is grief. Real grief, and it is not pathological. The fact that your person is still alive does not make it less real. The fact that others cannot see it — cannot recognize what has been lost while the body remains — does not make it less real.
You are mourning your witness. You are mourning the shared history that once lived between two people and now lives only in you. You are mourning the version of yourself that only this person knew — the you from the beginning, from before, from the years that accumulated into a life together.
That grief deserves to be named. It deserves to be witnessed — even if the person who once witnessed you best can no longer do so — can no longer say your name when they look at you.
— — —
For those of us who work in hospice, palliative care, social work, chaplaincy — this is worth holding as we sit with families in the long middle years of dementia. The caregiver who seems fine, who is managing, who says they are okay — may be carrying a grief so continuous and so unsanctioned that they have simply stopped expecting anyone to recognize it. Even when they are not utterly exhausted.
So — ask about it. Name it. Sit with it. Do not rush to reframe it or redirect it toward what remains. The grief is real. The loss is real. The witness is gone, even if the funeral is still years away.
What is being lived is one of the hardest things a human being can be asked to carry: the presence, in absence, of the person they love — the absence of the relationship that person once made possible.
— — —
I have no resolution to offer you. The witness does not return. The shared history does not reconstitute itself. What I have found — in my own life, and in the lives of the people I have been honored to accompany — is that naming this grief is itself a form of care and a form of respect. I have learned that refusing to look away from it, refusing to fold it silently into the general weight of caregiving, is its own form of faithfulness.
To grieve the witness — to name what has been lost while the person lives — is not a betrayal of them. It is an act of honesty about what love costs across a long life, and what it means to remain present to someone who can no longer remain fully present to you.
And sometimes, that is just the only faithfulness left available to us. To remain. To remember. To honor what was shared.
Robert Drake is an interfaith clinical chaplain, end-of-life educator, death doula, and grief counselor with over twenty years of experience in hospice, palliative care, pediatric oncology, emergency medicine, and medical aid in dying. He serves as volunteer Director of Spiritual Care Education for the Academy of Aid in Dying Medicine and works with individuals and families throughout the Pacific Northwest through Drake Living & Dying Design. He can be reached at Robert@DrakeLDD.com or Support@DrakeLDD.com.
by Robert Drake | Apr 28, 2026 | Uncategorized
A Companion Reflection to There Is No Fixing It
by Robert Drake
In a recent essay I wrote about the impossibility of fixing grief, and about presence as the only honest response to another’s loss. This is a companion reflection — another room in the same house. It begins with something I have been sitting with for a very long time, something I rarely hear named in all the conversations about grief and dying.
When someone we love dies, we lose more than them.
We lose a witness — sometimes the only remaining witness to parts of our life.
I have lost nearly twenty people dear to me — both parents, my kid sister, close friends taken too soon and too violently. Each loss has taught me things. But there is one thing they have taught me collectively, through accumulation, that no single loss could have shown me alone. This teaching usually comes only through many losses over many years.
With each death, a portion of my own life became unwitnessed.
My sister was two years younger than me. As children we shared a bedroom. We went to the same YMCA and the same summer camp all summer long for many years. We grew up inside the same world, the same family — five siblings and a father mostly absent. We climbed the same trees and roamed the same fields together. We shared the same particular texture of ordinary days that no one else inhabited quite as we did. She knew the child I was before I knew myself. She held a version of me — early, unformed, becoming — that exists now only in my own memory.
When she died, that version of me lost its only other witness.
We are known, truly known, only by a small number of people over the course of a lifetime. Not known in the casual sense of being recognized or remembered, but known in the deeper sense — witnessed through unique experiences and contexts and understood by no one else. Someone who was there. Someone who remembers who you were before you became who you are. Someone who can say: yes, that happened, I was there, I remember you then.
When that special person dies, the chapters of your life they carried die with them. Not entirely — you carry them too. But they lose their external confirmation. They become, in a sense, unverifiable. A private archive with only one remaining custodian.
This is not the same as missing someone, though you miss them too. It is something quieter and more disorienting. A portion of your own life has become suddenly unwitnessed and unanchored. And you may not find language for that feeling for a long time, if ever.
What I have come to understand, through the accumulation of nearly twenty close, personal losses, is that this is also a story about loneliness.
Not the loneliness of an empty house or a silent phone. Something structural, certainly spiritual. Something that builds slowly, loss by loss, over the years.
Each death steals a witness. Over time, more and more of your life exists only inside you, held by no other living person. Whole eras of who you were — the young person, the one still becoming, the one before the losses began, or eras in our older, still evolving lives — grow increasingly solitary. The people who knew you then, who were present in those rooms, those years, those ordinary days that turned out to matter more than anyone knew at the time — they are gone. And with them goes the shared reality of who you were.
I am seventy-two years old. I have outlived both my parents, my sister, and nearly twenty dear friends. There are chapters of my life now that exist only in my own memory. No one else remembers those times with me. No one else can confirm them, inhabit them, laugh or grieve over them alongside me. I am, for long stretches of my own history, the last witness standing.
That is a particular kind of loneliness. It does not announce itself dramatically. It accumulates. And it is one of the least named dimensions of a life lived long enough to love many and lose many.
No one but Kirk was with me when I drove my Porsche off the mountainside into the snow from an icy curve in Bear Valley. No one but Colin would remember looking at each other during the psychedelic years of the seventies and understanding what I was seeing or thinking without having to speak it. No one but Joe would know the icy cold and deep peace of the early fishing morning in the White Mountains of Arizona. No one but Mom would remember me and understand my reasons for hitchhiking through Mexico or wanting to study Arabic after camping with the Bedouin. No one but Carol would remember me telling her, clinging to a limb below me, to climb back down from the tree I was already climbing or I would have to pee on her — she did not climb down. No one but Richard would remember seeing the Little People deep in the desert of Death Valley. Only Rod could speak of my nature as a young man and his roommate in Bloomington as a young philosopher. Dad alone would know my pride catching my first fish. And my first wife alone knew me as a brand new father — an imperfect one, for sure — but that is part of the reality that seems now a little less real.
For those of us who work in end-of-life care — in hospice, in palliative medicine, in social work and chaplaincy — this is worth holding as we sit with the dying and the bereaved. When someone is losing a spouse of fifty years, or a lifelong friend, or a sibling who shared their childhood, they are not only losing the relationship. They are losing the person who remembered them young — who remembered them when. Who knew the story from the beginning. Who held the evidence of a life lived.
That is an enormity that deserves to be named, not folded silently into the general weight of grief. It is something to be grieved in its own right — named honestly as loneliness.
And there is this, too, for those of us in this work: even our patients take something of us with them when they die. The ones we have sat with for months, laughed and cried with, accompanied through their final season — they knew us in a particular way that no one else did. They witnessed us in our caring, in our presence, in our most human moments alongside them. When they die, that witness goes too. We carry our patients’ losses. We rarely speak of the losses they carry of us.
For the bereaved reading this: if your loss has left you feeling not only bereft but somehow less real — less confirmed in your own history — that is not confusion or self-absorption. That is one of the truest things about grief, and one of the least spoken.
You are not only mourning them. You are mourning the you that only they could see — that only they knew.
There is no resolution to offer. The witness does not return. The loneliness of outliving them does not fully resolve either — it becomes, over time, part of the landscape you inhabit.
What I have found is that naming it matters. That sitting with this particular grief — the grief of the unwitnessed self — without flinching from it or rushing past it, is its own form of faithfulness. To them. To yourself. To the reality of what was shared and what has been lost.
Grief is not pathological. It is the natural cost of having been witnessed, and of having witnessed in return. It is the price of having been known. And then of having lost.
And the loneliness that accumulates as the witnesses go — that is not a malfunction either. It is what love looks like across a long life. It is what it means to have been present, truly present, to the people who made you who you are.
There is no fixing that. There is only the willingness to carry it honestly — and to remain, as faithfully as we can, a witness to those who can no longer witness with us.
Robert Drake is a clinical interfaith chaplain, death doula, eco-theologian, mediator and end-of-life educator with nearly twenty years of experience in hospice, palliative care, psychiatric, pediatric oncology, emergency medicine and medical aid in dying. He serves as volunteer Director of Spiritual Care Education for the Academy of Aid in Dying Medicine and works with individuals and families throughout the Pacific Northwest through Drake Living & Dying Design. He can be reached at Support@DrakeLDD.com.
