Triggered by a chance pastoral encounter with a nurse who articulated a sense of the presence of God in the midst of existential darkness, this study seeks to explore two underlying questions: “In the context of health care, where is God in the “dark places” of human experience”? and “How is that experience discerned and communicated to others?” It will show how a greater understanding of these questions will add value to the provision of pastoral care in the health care environment by enabling a tailored intervention to be offered that will be to the benefit of the patient and their clinical and pastoral outcome. The research uses insights gained from academia, including theological and health care literature, to explore the former, and a musicological review to explore the latter. These are set alongside qualitative material in the form of case studies and taped interviews. Whilst this study suggests that credible belief in God is possible if God can be seen to be involved with, and supportive of, humanity in the midst of its suffering, it also shows that the way that experience is discerned and thus communicated to others, involves a process of listening and performing comparable with the act of music-making. As with its musical counterpart (incorporating elements of melody, rhythm, dynamics and timbre), this research maintains that the process of pastoral listening and performing is also multi-faceted, existing on a number of different levels. An awareness of these enables the pastoral encounter to begin to be rooted in a process of meaning-making analogous with wisdom emerging out of lament. This research further suggests that one way such wisdom can be discerned is in the way that the lament within the pastoral encounter is itself framed, using musical form as one way of holding in relationship the tradition of faith with pastoral praxis. In using specific examples of music-making as a guide to effective pastoral care, this study concludes with recommended pastoral interventions pertaining to the pastoral practice of healthcare chaplaincy, advocating that through reclaiming the spiritual space and reframing the pastoral encounter, it is still possible for chaplains to model the presence of God.