Estimated Time of Departure: How I Talked My Parents to Death. A Love Story

Book Title: Estimated Time of Departure: How I Talked My Parents to Death. A Love Story

Author: William Donaldson

Publication Information: New York City, Aitia Press, an imprint of Morgan James Publishing, 2021, 103 pp., $12.95, paperback

William Donaldson’s Estimated Time of Departure serves as an intimate portrait of an adult child wrestling with the timeless challenges that come with planning for the aging, physical decline, and ultimate passing of his parents. Although Mr Donaldson explicitly notes that his book is not a road map, readers uncertain of how to approach conversations about aging and death with their loved ones or patients will find his story full of relevant tips and information. With loving kindness, Mr Donaldson takes us on a journey rich with all the sadness and joy that can be born out of open discussions about aging and death.

The book’s title and format is an homage to Mr Donaldson’s father, a pilot and aeronautical engineer, who was possessed by a lifelong love of airplanes and flying. Mr Donaldson’s journey is at once as deeply personal and universal as death itself. From chapter one, “The Departure Lounge,” to the book’s conclusion, the author uses the flight plan metaphor to deliver bite-size and digestible snapshots into the various legal, medical, and interpersonal aspects of successfully navigating the challenges of planning for the aging and passing of one’s parents.

After some relevant family biography, the author takes us on a stepwise journey from his parents’ downsizing of their retirement farmhouse all the way to their enrollment in hospice care and the planning of final affairs. Every crossroads is rich with poignancy and intimate detail that many patients and families will find quite relatable. Touching scenes like that of Mr Donaldson singing a final rendition of Cheek to Cheek with his mother, then too debilitated from a cerebellar stroke to dance, imbue Estimated Time of Departure with a humanity sometimes missing from more academic literature. That being said, Mr Donaldson’s story is indeed an upper middle class one. Absent are the unsavory details of Medicaid spend-downs and financial strain that many adult children will face as they struggle to navigate our byzantine long-term care system. Although Mr Donaldson does not address the inequities in our system head on, he is an honest and elegant writer who has given us a text full of insights and practical knowledge for families across all layers of the social strata.

Though not a physician, Mr Donaldson poignantly illuminates through personal anecdote a framework that medical providers at all levels may find useful when discussing end-of- life care with patients and families: the distinction between the biological and biographical stories of our lives. Within his framework, the kind of care we choose and the medical and legal documents we must review and sign to ensure our choices are respected reflect only our biological story. To have a successful take off, the author implores his readers to also be mindful of the biographical story of themselves and their loved ones. The biographical story, according to Mr Donaldson, is rich with the details of our emotional life, our most valued relationships, and our individual philosophy of aging and death. As a family physician who practices palliative care, I have often found myself intuitively operating within Mr Donaldson’s paradigm when facilitating advance care planning with patients and families.

However, students and physicians looking for reference material regarding advance care planning and end-of-life care will need to supplement their library beyond Estimated Time of Departure. Though Mr Donaldson does provide evidence-based answers to common questions regarding end-of-life conversations, the true value of this book is in its offering of the first-person perspective of a son doing his best to honor and care for his parents as they approach their final transition. Younger trainees and physicians will find that having a deeper understanding of this perspective serves them well as they approach difficult conversations with patients and families.

Overall, Mr Donaldson has added his unique voice to the canon of other recent popular literature on death and dying. The lay perspective he offers serves to both contrast and enhance that of more well-known physician-author counterparts such as Atul Gawande, Angelo Volandes, and Lydia Dugdale. Patients, family members, and physicians alike will find the pocket-sized Estimated Time of Departure a colorful and insightful text about life’s most immutable certainty.