Alex Beth Schapiro — Apophatic Art Practice and Research

The Third That Remains: Rituals for Patients I Never Met

I accompany patients for years without ever sharing the same physical space. As a healthcare chaplain within population health and digitally mediated care, relationships unfold through virtual encounters—video visits, phone calls, texts, and the medical record. Some of these relationships persist, even thrive, over years.

When death occurs, it often arrives outside the hospital walls, as a digital notification or a message from a loved one. I sometimes feel a sudden desire to see their face for the first time—or from different angles—to match my mind's image with the wholeness of their life. There is also the impulse to learn more: to better understand the community around them, or how they were mourned. Yet pursuing that knowledge feels like a violation, collapsing a distinct relational boundary.

A distinct relational closeness had emerged—a third, co-created between or among us, never to exist again. When the patient dies, the third disappears with them.

How might such a third be grieved by the clinician who remains? These deaths leave clinicians without shared rituals of mourning. Yet the patient's identity must remain protected. I cannot tell their story or represent the life that unfolded beyond the fragments we shared—fragments that remain necessarily obscured.

And what else remains? Continuing Bonds theory suggests relationships may continue, transformed, after death. What remains may be the relational space briefly formed between us—the co-created singular spark of attention, care, or recognition.

The project develops a minimal quilting practice marking the relational third's fleeting appearance. Through repetitive stitching, fabric fragments are joined while each remains partial. Each stitch refuses to represent what cannot ethically or actually be known. Quilting is a particular choice—my grandmother's practice, an inherited choreography of hands. This practice asks whether mourning can occur at the limits of representation—where recognition is possible, but knowledge remains incomplete.

Alex Beth Schapiro is a chaplain working at the intersection of spiritual care and population health. They trained in palliative care chaplaincy at Mount Sinai and Columbia, and in relational psychoanalytic theory at the Stephen Mitchell Relational Study Center. Alex directs a digital Spiritual Health program within the Accountable Care Organizations at Atlantic Health in Northern New Jersey—launched in 2022 with support from a John Templeton Foundation initiative and the George Washington Institute of Spirituality and Health, now an ongoing model for ambulatory spiritual care. They co-convene the Population Health & Digital Spiritual Care Network through Transforming Chaplaincy and the Telechaplaincy Community of Practice in partnership with the University of Zurich.

Their work centers on care for the spiritually unaffiliated, the integration of psychodynamic approaches within long-term relationships of care, peer supervision, and how healthcare workers might attend to their own grief.