Several years ago, I met Brian*, a young adult who was living with stage 4 lung cancer. The highly aggressive disease had metastasized to multiple parts of his body, including his brain. In our lengthy conversations over many music therapy sessions at the hospital, I was struck by his focus on legacy. He told me he was constantly wondering if and how he would be remembered. At only 27 years old, he was at once youthful and existentially weighed down by the reality of the disease progression, eager to soak in as many experiences as he could while being mindful that his time was limited. As a music therapist, I often focus on “legacy work” through songwriting as a vehicle for creative self-expression but also as an offering to the patient’s family. The songs I write with patients who are receiving palliative and end of life care often represent that which holds meaning to them. We write songs for loved ones, about loved ones, about oneself, about hopes, dreams, regrets, ideas, and reflections. Sometimes the patient wants to infuse humour, other times the lyrics and chord progressions are pensive, even melancholic. However, the songs come together, they always serve as a form of legacy. Perhaps that is an intrinsic outcome of songwriting: it’s inherently representative of a point in time and can be revisited as a reflection of that moment, of that person, of that experience or relationship. In one of our music therapy sessions, I introduced the idea of songwriting to Brian, who immediately connected with the concept and told me he’d be thrilled to try it, though he wasn’t sure what he wanted to say or how the process would unfold. Together, over several weeks, he and I crafted lyrics, which he would later speak atop a chord progression we created. He told me he wanted the chords to feel “deep, painful, yet hopeful,” a contrast which he named as his own current reality, as he was balancing living while dying. I had heard of other music therapists recording patient heartbeats with a stethoscope and using the audio as a backing track of sorts, a rhythmic line that threaded through the song. Having just been generously gifted a digital stethoscope from a community organization, I knew in my own heart that Brian would be the perfect first patient for me to create a heartbeat recording with at the hospital. With a little help from my nursing colleague, we recorded Brian’s heartbeat, embedded the sounds into the track he and I had written and recorded, and a few days later, presented it to his family. Brian died several months later but his vitality remains embedded into the song he wrote, both in the music and lyrics but also in the acoustic representation of his life force: his heartbeat. Over the past several years, music therapists have been using heartbeat recordings as legacy work with patients and families in a number of settings including but not limited to oncology, pediatric intensive care units, and hospices. Last year, together with the Adolescent and Young Adult (AYA) Oncology Program at Princess Margaret Cancer Centre , the Music Therapy Program launched a “Heartbeat Recording for AYAs” research project where we will be writing songs with this patient population and researching the lived experience of the legacy work and heartbeat recording for these patients. We’re so thrilled to be able to carry on this work as a research endeavor and hopefully come to a richer understanding of the impact of this songwriting approach. When I reflect on the work Brian and I did together, I’d like to think he would be excited to see this type of legacy work expanded for adolescents and young adults. Perhaps his courage to be the first patient to trial this experience is part of his legacy, too, and I will be forever grateful. Dr. SarahRose Black PhD RP MTA is a certified music therapist and registered psychotherapist, specializing in palliative care and psychosocial oncology at the Princess Margaret Cancer Centre, and her private psychotherapy clinic (Whole Note Psychotherapy) in Toronto, Ontario. She is a pianist, vocalist, and music health educator, and has performed, taught, and presented on her clinical work and research across Canada.

Music is everywhere. It plays in the background of waiting rooms, fills quiet spaces, and is often added to care environments with good intentions. But music care is not just about playing music. The difference is intention. In music care, intention means using music with a clear purpose. It is not just about what is playing, but why it is being used, when it is introduced, and how it supports the moment. It is the difference between turning on any playlist and choosing the right piece of music for what is happening right now. This shift may seem small, but it changes how music functions in care. When music is used intentionally, it moves from background to something that actively supports the care process. A familiar song used at the same time each day can help signal routine. A slower tempo can support calm during moments of agitation. An upbeat rhythm can encourage movement and participation. In each case, the music is doing something. It is not just filling space. It is supporting care. At its core, intentional music care can be understood in three connected ways: Use: How music is used in the moment Design: How music is structured and selected to support care Performance: How music is expressed and adapted to suit different settings and care scenarios 

With the Juno Awards taking place this past weekend, there has been a renewed focus on the role music plays in Canadian culture. It brings people together and creates shared moments. This same idea surfaced in a different context earlier last week. During the recent Ontario Long Term Care Association conference, a keynote from Mike Downie, Telling Our Story: The Power of Narrative to Inspire and Connect, reflected on the legacy of his brother, Gord Downie, and the impact of The Tragically Hip. One of the main insights of this reflection was a simple idea: music connects people. During the keynote, reflections shared from residents at Kensington Health offered a powerful reminder: Music is a common ground for community gathering It is not about what is lost, but what is still there Music that has meaning can bring us back, even if only for a moment Mike Downie also reflected on how the storyteller can become the story. This is a clear theme in the life of Gord Downie, who was known for storytelling through his lyrics and later became the story himself through his health journey. His later work, including Secret Path , also highlighted his advocacy for Indigenous communities and demonstrated how music can be used to share stories that might otherwise go unheard. In care environments, this idea shows up in different ways. Projects like The Green Bench create space for people to share their stories directly. Music can do something similar. It can bring forward identity, memory, and moments of self-expression, even when communication changes. These reflections may feel familiar to those who work in care environments. It may look like a resident quietly joining in with a familiar song, or a shared moment where a room shifts as music begins. Connection through music may appear as: A familiar song leading to singing or humming A moment of recognition seen in a glance or a smile A shift in the tone of the room when music is introduced These moments of connection are often described as spontaneous. However, they are not accidental. Music, when used intentionally, can support connection in everyday care. This might look like: Choosing music that is familiar and meaningful to the person Using music to support transitions or care routines Creating opportunities for shared listening or singing The legacy of Gord Downie reminds us that music has always brought people together. In care environments, through the intentional use of music, that same connection continues.

Professionally, I have continued to develop my skills as a hand drum facilitator, moving beyond technique into a more intentional, care-focused approach. Incorporating Music Care strategies into drumming has transformed how sessions feel and function, allowing rhythm to become a tool for connection, engagement, and emotional expression. One of the most impactful strategies I’ve used is picking songs for care contexts during drumming facilitation. Choosing familiar and meaningful music creates instant buy-in and excitement. Some of the most joyful moments have come from drumming along to ABBA and AC/DC, songs selected by both team members and residents. These shared musical choices encouraged participation, helped everyone catch the rhythm more easily, and created an atmosphere of laughter, movement, and shared energy. The familiarity of the music allowed participants to feel confident and included, regardless of their musical experience. To support inclusive and adaptable sessions, I intentionally assembled a Music Care Kit tailored specifically for drumming facilitation. My kit includes a variety of drums, some smaller, some larger, and others with handles to support different hand grips. I also include drumsticks of varying weights to ensure adaptability for different strengths and abilities. A speaker is essential for song-based drumming, along with facilitator notes that help guide session flow. Additional instruments, such as chimes, allow me to introduce moments of calm during drum washes, while a jam drum block supports call-and-response interactions. Even my portable tote has become an essential part of the kit, allowing me to easily transport everything from one community to another. This flexibility ensures music care can meet people where they are. Music Care has also become a vital part of my personal self-care. I intentionally use music while driving to work as a way to decompress from the previous day or to prepare myself emotionally for a compassionate and grounded workday. This simple practice has helped me manage stress and transition more mindfully between personal life and professional responsibilities. Beyond daily routines, music now shapes how I experience the world. As part of my personal Music Care Plan, every vacation I take includes music as a way of learning about culture, history, and identity. In Norway, I attended a midnight concert in a local church in Tromsø and sang along with an Indigenous Sámi man who shared a song about his grandmother. In Poland, I experienced a Jewish Kazimierz performance featuring violin, singer, and accordion. In Ireland, I listened to harp and flute music at the base of the Rock of Cashel and played the drums at the Ireland Rock and Roll Museum. My travels also included attending Mozart, Strauss, and Beethoven concerts in Vienna, visiting Mozart’s birthplace in Salzburg, and participating in the Silent Night Chapel service on December 24. Each experience reinforced how music transcends language and creates a sense of belonging across cultures. Looking ahead, my journey with music continues to evolve. During my hand drum facilitation course, I unexpectedly fell in love with the didgeridoo. The low tones and full-body vibration felt deeply soothing and grounding. Quietly, I’ve signed up to learn how to play. This instrument requires internal and circular breathing, something I find challenging due to ongoing lung issues, but I see this as an opportunity rather than a limitation. Learning the didgeridoo may support Motor and Respiratory Exercises (OMREX) ® , a core Neurologic Music Therapy technique that uses singing and wind instruments to build respiratory strength and control. Through diaphragmatic breathing, increased expiratory pressure, and improved breath control, this practice has the potential to benefit both my personal health and my future work in care settings. Music Care has reshaped how I drum, how I travel, how I breathe, and how I care for others and for myself. What began as skill development has become a way of moving through the world with greater intention, curiosity, and connection.

As a psychologist and a researcher, I spend my days exploring the incredible benefits arts engagement can bring to the health and well-being of individuals across the lifespan. A particular focus of my work is on music, be it group singing in choirs, intergenerational music therapy that connects young children from the community with residents of long-term care homes, virtual opportunities for families to sing together from a distance, or high-quality concerts provided by professional musicians. Given my background, you’re probably wondering how I ended up leading a holiday sing-along with Toronto Mayor Olivia Chow in November… My current role is the perfect match for my longstanding interest in the arts. My love of music began at an early age. As I was the only niece living close by, I was my aunt’s regular “plus 1” for all sorts of musical performances coming through Montreal’s Place des Arts and Bell Centre. Growing up singing in choirs at church and in high school led to performances with the Hart House Singers when I moved to Toronto for graduate school. Over the last few years, my singing has been more commonly directed to an audience of two small children (and a cat), and I’ve harnessed my love of group singing into my research: I am currently involved with the SingWell project, an initiative out of Toronto Metropolitan University that examines physiological and quality of life benefits of group singing for a variety of populations, including individuals living with hearing loss, Parkinson’s disease, and dementia.  So imagine my surprise and delight when I recently had a powerful reminder of the personal joy of group singing. One chilly day in November, I had the opportunity to walk in my local Santa Claus parade with the Mayor of Toronto. As we neared the end of the parade route, there was a bend in the road where our group decided to set up and play some holiday tunes. Unfortunately, it seemed as though the sound system was out of order, and Mayor Chow turned to the group and asked “who likes to sing”? I sprang to respond, flung up my hand, and was immediately brought to the front of our crowd and found myself- unexpectedly and delightedly- leading an extremely enthusiastic and joyful choir on a street corner just blocks from my home! We sang for about 15 minutes, cycling through a repertoire of tried and true holiday favourites, sometimes stumbling over the words, sometimes getting an assist from people passing by! Folks who were completing their own parade journey, joined in, sang along, shouted encouragement, smiled and waving as they passed. While singing, my inner scientist couldn't help but wonder- were my cortisol levels decreasing? Maybe my oxytocin, the human bonding hormone, was shooting through the roof! This unique opportunity was the perfect representation of so much of the work I have been doing for many years. Seeing so many faces breaking into smile (and so many people breaking into song!) was a keen reminder of the power of music to connect us, and emphasized the important work that the room 217 team does every single day.