Describe the time of day and weather at the time of the accident:
The afternoon sunlight burst through my windshield with a Machiavellian magnificence, creating streaks of golden radiance that danced through my careening automobile.
Were you wearing a seatbelt at the time of the accident:
I remember tugging at the seatbelt with great fervor, convincing myself that it was strangling me in an attempt to keep me safe, when actually, ‘twas I endangering the sanctity of the seatbelt with my thoughtless behavior.
In your own words, describe the cause of the accident:
Samantha said I loved the bottle; a bit too much at times. Often, when I would come home late and stinking drunk, she claimed I loved the bottle more than I loved her. Perhaps she was right. But a man in my line of work needs all of the numbing agents he can get his hands on. I remember saying to her one time, “Sam. Babe. Why you going all extreme on me? If you’ve seen some of the things I’ve seen, Toots, well, let me tell ya, you’d think twice about giving me a load of shit.” Ah, Samantha, has it been that long since we last talked? Since we last touched?
Did you sustain any injuries because of the accident:
I remember looking at my shaking hands holding loosely onto the steering wheel. I focused on them as best I could and saw long, deep wrinkles, each one representing a trial or adverse scene in my life, each one more painful than the last. How many of these tests in life have I passed? More importantly, how many have I failed? The air bag had failed to deploy, causing a deep bruise on my forehead. It would heal in time. My pride, however, would not. Hell, I could have used another scar. Just tack on another failure. Oh, Samantha, where are you, babe?
If possible, name the other people involved in the accident:
Samantha and I used to picnic off of highway 341, taking the Gladstone exit and barreling up the hill on Brookview Road. From a distance, we would see our secluded spot; a grand oak tree that stood in front of the entrance to a grove. As a child, my friends and I would venture out there on our Schwinn’s and play Kick the Can until either dusk or when we fell over each other from youthful giddiness and innocence. Samantha and I carved our initials into that same tree years later, where the indentation of my ’93 Saturn’s fender now lays.
Comments welcome! Please leave this form in the break room or make copies and pass them out at random coffee houses or any place where you may find publishers. Thanks!
Insurance Agent’s assessment/comments (office use only):