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and beloved windowsill where I park my coffee. She is always fifteen minutes late to class, rolls in unapologetically after Frank has begun the lecture, and throws her backpack down on the floor. She is in many ways my exact opposite. While I smile at everyone, she glowers. Dot looks rumpled, while now that my depression has been replaced by a feverish study of emergency medicine I have standing orders at the Georgetown dry cleaner for my shirts to be laundered with extra starch. Dot always wears jeans, a big ungainly windbreaker, and hiking boots. My cowboy boots are custom-made and my jeans well ironed. Her casualness is one reason why I am in despair that she has gotten 100 on the paper. “You got an 80?” she says.
    She has stopped one micron before saying the words
I
thought you were smart
. “It’s not you,” she says. “It is this test. It is a semantic mess.”
    As Frank lectures to us she scribbles wildly on her notebook so I can see it, something I haven’t done since the seventh grade. Dot tells me she has a Ph.D. in semantics, and she goes into furious detail about every flaw in the questions. I appreciate her making an excuse for me. To her way of thinking, I am simply too smart to take a dumb test. I don’t have the heart to tell her that the semantics really were not the problem, the problem was that I simply didn’t know the answers to 20 percent of the questions. I imagine standing over a dead body in the back of the ambulance and telling the grieving family that it was not my medical error but merely a matter of semantics that I failed to save their loved one.
    I am having a problem my shrink tells me is often experienced by first-year medical students. I have every symptom of every disease Frank mentions in the classroom. I am no longer clinically depressed but instead am dying of everything simultaneously.
    Now I have fancy words for what is wrong with me. I am no longer sweaty. I am diaphoretic. My hand wanders constantly to my neck to check my carotid artery to see if my pulse is thready or bounding. I am no longer breathing rapidly but I am suffering from tachypnea. I have all the symptoms of a heart attack, a stroke, an aneurysm. I feel impending doom, my heart races, my hands tingle, I can’t feel the right side of my face. When I am not enmeshed in my imminent death from medical problems, I am obsessing about all the impending scenarios of trauma waiting out in the world.
    A car is not fun to drive anymore. It is a metal cage waiting to kill me in a dozen ways I have never thought about. I can get trapped inside underwater. The rescue personnel will not be able to free me thanks to Ralph Nader, a man I once admired but who now, as all EMTs know, is clearly Satan, having been responsible for cars whose doors do not fly open in a crash and come with safety glass that can’t be shattered easily to free the victim. When Nader’s name is mentioned the paramedics and firemen sneer and make the same spitting noise my Jewish grandmother made at the mention of the Nazis.
    Terrible things can happen in cars. The seat belt can crush my intestines, my head can hit the dashboard and send my brain bouncing around inside my skull like a Pac-Man figure under siege. It isn’t just cars. After about ten classes everything in the world has become an accident waiting to happen. Dogs have teeth that cause severe puncture wounds, the propane gas tank on our outdoor grill can explode and level the whole block. Have a cocktail and you can get sloppy about chewing and choke to death on a hunk of steak. Bees can sting you and anaphylaxis can set in, causing you to suffocate. UPS trucks can carry up to seventy-five pounds of unnamed volatile chemicals. Babies and children are walking disasters, their big heads and delicate bodies designed for toppling, their large tongues for choking.
    Frank stands before the class and tells us, “One out of twenty of you has a main artery that is congenitally faulty and will at