Nietzsche's question

I've been busy, working multiple jobs, and thinking I ought to post more. I finished up one of those jobs on Monday, and start CPE (clinical pastoral education, a sort of chaplain internship) next Monday; in between I'm continuing my work at the local hospice.
Yesterday at the hospice I was talking to one of the other chaplains, and we were trading stories about our first careers and our call to ESR (including that sense, "I don't know why I'm here, but I know I'm in the right place"). I briefly described my book to him without going, I think, into too much detail.
Afterwards I was reading the chapter in the text for CPE on caring for the terminally ill (since that's what I do in hospice), and the interconnection between my work on Nietzsche and hospice chaplaincy really struck me.
The problem Nietzsche faces is this: a rigid belief in God that places blame on people for what happens (in a manner reminiscent of the response of Job's friends) or a rejection of any framework of meaning, e.g., nihilism.
What do I see at hospice? Either their suffering has meaning as part of God's plan, or else it's just something that randomly happens to people. And those aren't very comforting alternatives: either God is making me suffering (because of the bad things I've done / because it's part of a greater good that I can't understand) or else it's just pointless suffering. This is really the question of theodicy writ small, the question of meaning inscribed on the individual's life. "Why me?"
Nietzsche is looking at a world in which belief in God is no longer tenable; you can disagree with him, of course. However, I suspect that anyone reading my blog would agree that the sort of belief that Nietzsche rejected is no longer a serious option, unless you simply reject a lot we now know about the world. Therefore, our religious beliefs need to be modified, at the very least. Nietzsche chose Dionysus as a placeholder for this new belief (I say that to contrast him with neo-Pagan and the so-called Druids, since Nietzsche doesn't actually think he's reviving an ancient tradition). Most of the people I know wouldn't go that far, but they're also not fundamentalists, i.e., they have a more flexible understanding of a Higher Power.

I don't teach people about Nietzsche, but I do see that same question rising up in people. Where is that alternative that suggests a constructive meaning?