The Show Must Go On
By Erin Howe
Art has always been part of Grant Lum’s life.
As a teen, he played classical and jazz trombone. Later, he led a band and wrote for the Temerty Faculty of Medicine’s annual student musical production Daffydil.
“For many of us who work in performing arts medicine, this is our day job,” Lum jokes . “ We’re just waiting for the big break.”
Lum (BSc ’89, MD ’92, PGME ’94) is a physician who treats injuries in artists. Many of the people he sees work in physical disciplines, such as dance or acrobatics, and face a variety of biomechanical demands related to their craft.
“As my own vocal coach used to say, ‘It’s all about the instrument,’” comments Lum.
Artists are prone to a variety of injuries. For example, a violinist tilts their head against their instrument’s chin rest, straining their neck. A ballet dancer develops osteoarthritis in their hips after years of dancing. Or, an actor in a musical develops back and shoulder pain because they are required to dance and sing while wearing a heavy headdress as part of their costume.
Many artists’ injuries are similar to those sustained by professional athletes. But others are unique to artists, says Lum, an assistant professor in the Department of Family and Community Medicine at Temerty Medicine.
Lum has been a physician consultant to sports organizations including the Canadian Football League, the NHL Players’ Association and Squash Canada. He has worked for Ballet Jörgen and Toronto Dance Theatre, and been in the wings to treat actors during Mirvish theatre performances.
A hockey player might face a greater risk of acute injury during games, which are once or twice a week. But for artists who perform six nights plus two matinees a week or who do a nightly show for weeks at a time on tour, the volume of work can create or compound injuries.
* * *
Audiologist Marshall Chasin helps musicians prevent and manage hearing loss.
Whether the score is heavy metal or Mozart, music can register at 120 decibels — the sonic equivalent of the noise generated by a chainsaw or motorcycle engine.
And though all musicians are exposed to loud sounds, the degree of exposure varies.
“A classical musician often works five or six days a week. They practise three or four hours a day, perform three hours at a time and then, they might teach three or four hours a day,” says Chasin, who is also the director of auditory research at Musicians’ Clinics of Canada and an adjunct linguistics professor at the University of Toronto Faculty of Arts and Science. “But a rock and roller may pick up their guitar for a Friday night gig and then may not perform again for another week or two.”
Chasin also prioritizes stress management at his clinic. He points to research that shows that stress can increase a person’s susceptibility to hearing loss.
Under stressful conditions, including negative feelings toward a set list, the adrenal glands emit high levels of the stress hormone cortisol, which causes an increase in glutamate, a neurotransmitter that is toxic to the ear, explains Chasin.
He explains that while a pop musician likely writes and chooses their own music, members of an orchestra have to play what their artistic director chooses.
“It could be a piece the musician loves, or it could be a song they’ve played as part of a long-running show like Cats. It’s great music, but not after the 300th time playing the same thing every night,” says Chasin.
Your identity, work, purpose and passion are all tethered to being able to use your body as your instrument
* * *
Second-year medical student Ryan Booth has already had his time in the limelight.
After training with the Royal Winnipeg Ballet School, Booth joined the National Ballet of Canada as an apprentice. He danced in the company for three years before moving to Europe to work for the Vienna State Ballet and Royal Danish Ballet. He spent nine years dancing professionally before entering Temerty Medicine’s MD Program in 2021.
Booth, who received the Carlo Fidani Student Bursary, recalls the delicate balance of enjoying his first career while planning his next act. A ruptured meniscus prompted the dancer to think about what might wait in the wings for him after his final bow.
“It’s terrifying to be injured. You’re immediately sidelined from your work, and the setback can feel monumental,” he says. “Your identity, work, purpose and passion are all tethered to being able to use your body as your instrument. It’s debilitating physically and emotionally.”
An injury isn’t the only factor that can affect an artist’s mental health.
In addition to other conditions experienced by the broader population, such as depression and substance use, performance anxiety and financial worries can weigh heavily on an artist’s mind.
According to statistics gathered for the Canada Council for the Arts, the Department of Canadian Heritage and the Ontario Arts Council, Canadian artists, on average, earned just $17,300 in 2019 — less than half the median of all workers.
* * *
Paul Uy (PGME ’13 & ’16) is a lecturer in Temerty Medicine’s Health, Arts and Humanities Theme and a psychotherapist at the Al & Malka Green Artists’ Health Centre at UHN. In his office, one of the struggles he helps people with is reconciling their perceptions of productivity against societal and economic pressures.
“These are people who dedicate their lives and their energies to creating something meaningful for society,” says Uy. “And right now, our society doesn’t really value the artistic process as a vital component of society.”
Uy notes that an artist’s creativity and originality is a strength for working through psychotherapy. A person’s craft may provide a medium for them to express emotion, be a creative process for problem-solving or a resource for understanding the challenges that brought them to his office.
And as much as they may use their art to make sense of the world for themselves, artists also help others to come to grips with their problems.
“Art is essential for society, and creative people help fuel resilience in others,” says Uy. “We all take refuge in music, books, movies and other works of art to help us face the consequences of being human in a rapidly changing world.”