To a Young Woman in a Hospital Bed

It starts with an urge, she says, innocent
enough: clipping her fingernails
to the cuticle, paper cuts

she slits along her hands, or scratching up
her arms in homeroom with a plastic knife
to scare the gawking boys.

Eraser burns: those competitions
to see which of her girlfriends
flinches first as she scrapes the rubber

edges across her forearms, biting
down on a wooden ruler
so she won’t scream, or stop.

Then she gets good at it: she always wins.
She does it on her own, rubbing
the eraser over black scabs, trying

to wipe …