A UVM undergraduate majoring
in biology with a minor in gender studies, Ann Wong (at right) has been a researcher on Gramling’s team since the spring of 2020. She has spent many hours in the Conversation Lab—headphones perched on her head—listening
to some of the intimate moments in the lives of patients facing the end of life. The gravity is not lost on her.
“They were definitely very difficult, heavy conversations, but it was a really enriching experience to be able to hear
that vulnerability and to have the honor of being able to listen to those words,” she says.
Wong has been focused specifically on silences. When they appear in a conversation, she’s tasked with noting their presence and categorizing
them based on what they signify. Two fellow researchers in the lab—Cailin Gramling and Brigitte Durieux—created a code book and a 1-3 scale to help guide the process. A “one” is an “invitational connectional silence,”
where “there’s a question and [the speaker] is trying to invite a conversation,” says Wong. A “two” is an “emotional connectional silence,” characterized by a silence of a couple of seconds or more following
a moment of gravity, whether it is an unfavorable diagnosis or a difficult decision point. The “three” indicates a deeper exchange that invites further dialogue.
“Immediately following an emotional connectional silence,
there’s an acknowledgement of the moment of gravity. Quotes that we’d hear are: ‘That’s a lot to take in,’ or ‘Can you tell me more?,’” Wong says.
Sometimes, the work is more art than science,
reliant on a team of people willing to parse slivers of a conversation—quite literally the absence of words in two- to three-second intervals—for what may be happening in that space.
“If there was ever conflict, then we’d
have a group listen and determine what we thought the code was,” says Wong. “And sometimes someone would say, ‘I thought that was a moment of gravity,’ and then another coder could be like ‘Oh, I didn’t really think
so.’ It was interesting to see how our different brains worked with what we identified.”
These exchanges are critical to a process that hinges on context and culture. Each member of the team brings a unique viewpoint that taken
together helps to arrive at a common understanding.
“We’re just starting to publish on some important ways of developing a taxonomy of silences,” says Gramling. “What are they? And can we find them in ways that are
reliable and valid and that are not overly culturally defined? Because what counts, what looks like connection in one setting, in one context, in one person’s experience, may not be in another. We have to make sure that we’re open to all
different definitions of what human connection can be.”
This summer, Wong is applying what she’s learned to the StoryListening Study, parsing the exchanges between participants and doulas for silences and other communication
patterns that may help to identify moments of connection.
Silences are just one piece of the puzzle. Previous publications from Gramling and his team— dating back more than a decade—have explored a variety of language patterns
in serious illness conversations. One study published in the Journal of Pain and Symptom Management focused on correlations between expressions of anger and clinical outcomes. Another in the Journal of Palliative Medicine describes
a tandem human and machine coding method to identify connectional silences. Most recently, the team, led by a recent graduate of UVM’s Computer Science doctoral program, Larry Clarfeld, Ph.D., and former chair of computer science, Maggie Eppstein,
Ph.D., published a paper in PLOS One detailing a “computational model of conversation flow in serious illness conversations,” which stands to serve as a “fundamental tool in conversational epidemiology.”
Conversation Lab’s database contains over one million words of conversation—more than ten thousand minutes of patients, family members and health professionals talking—all of which has been poured over to understand what defines
moments of connection. In collaboration with his brother, David, Gramling has written what is perhaps the definitive book in the field, titled Palliative Care Conversations: Clinical and Applied Linguistic Perspectives.
StoryListening Study, Gramling is excited to see how the work unfolds, leaving open the possibility for entirely new lines of inquiry to emerge.
“There’s going to be some sense of discovery,” he says. “We know we’re
going to go after some things like the turn-taking, the silences, moments of human connection based on some existing definitions. But we’re also going to maintain the openness to discovery… we have to redefine what we’re looking
at and make sure we can reliably find [and name these moments].”