When a dying cancer patient named Kayla rejected Judaism's traditional deathbed confession as failing to reflect her complex relationship with God, it sparked a pioneering exploration of personalized end-of-life liturgy within Jewish tradition. Through collaborative consultation, a new prayer emerged that wove together traditional liturgical elements with Kayla's distinctive spiritual voice - including her anger at God, dedication to tikkun olam (repairing the world), and feelings of distance from conventional religious community. The development process involved multiple revisions through direct patient consultation until the prayer authentically captured her beliefs while maintaining connections to Jewish textual tradition. Detailed textual analysis reveals how each prayer component adapted traditional elements to address contemporary spiritual needs, demonstrating that personalized liturgy can bridge individual theological concerns that conventional prayers may not reach. The methodology and outcomes contribute valuable insights to pastoral care approaches, liturgical adaptation practices, and understanding how religious leaders can create meaningful spiritual resources for individuals whose experiences diverge from traditional frameworks, particularly in end-of-life contexts.