We get ten new adolescents a week at the psych hospital where I work. Sometimes seven in one night. Around five-hundred a year. Some come from ERs with pumped stomachs and charcoal breath. Their bodies mutilated. Cuts up and down both arms and other places we’d just as soon ignore. Some have fresh stitches beneath bandages. Their minds tortured with self-hate. Some are goth, others only misfits that are bullied at school. Some have been physically abused, raped, or suffered many broken relationships. They feel like lunatics, losers, the lost, the damned. They come walking through the hospital door or riding on a gurney, squeaking down the corridor. Searched and showered. Rubbing their eyes, unable to wipe away the strangeness of what they see.

It’s my job to build self-confidence. I’m the creative writing teacher. I pitched the class to the senior therapist after earning an MFA. I told him I would like to start a creative writing workshop that combined writing and counseling, focusing on what they are saying about themselves through the characters in their stories. The depsrtment gave me a three-month trial to see if the adolescents would like such a class, and now it’s been going for three years.

I’ve taped pictures on a whiteboard in the classroom that I’ve cut from The New Yorker magazine and from The New York Times—pictures to illustrate the fiction written and reviewed within their pages. On the backs of the pictures, I’ve written a set of writing prompts. They choose a picture, and I set a cooking timer to twenty minutes and say, “Go.”

Today they gather in my class and scan the whiteboard. I watch their hands reach for pictures. I’m pacing. They take a seat at the table and begin writing. All nine of them—five girls, four boys.

After they finish writing, I say, “We’re going to read them aloud. Who wants to go first?”

One girl—Emily, I&rsquo&ll call her—raises her hand. Her hair is dyed black with blonde highlights. She is wearing skinny jeans, a black hoodie and a pair of classic black high-top Converse sneakers She’s been living with her aunt since her mother died from an overdose. Her aunt padlocks Emily’s bedroom door at night. The aunt says she’s afraid of Emily. She believes Emily might kill her in her sleep. So she positions the padlock, snaps it shut, then walks to her bed and slips beneath the covers. Safe for another night.

Locked inside her room, Emily squats and pees in a bucket the aunt has given her. She dumps it in the morning. She showers. She dresses. She goes to school. But last week she ran away and went missing for two days. Now the Department of Human Resources is involved.

I ask her what she does in her room to pass the time. She says, “I read.”

“What do you read?”

“Different stuff, but my aunt doesn’t want me reading too much. So I have to sneak library books from school into my room. I slip them inside my binder because my aunt never checks it.”

“That’s smart,” I say.

She smiles.

“Okay, show us the picture you chose, and then you can begin,” I say.

Emily holds up a picture of a girl with a sad face sitting on her bed. I’ve written on the back, “Why is this girl so sad? What happened?”

“It’s sort of a true story, I guess,” she begins.

“Okay, go for it.”

She says she doesn’t really know her father, that she sees him in every scar on her body. “Deeper I go, looking, further into the vortex of tissue, every vein emitting little cries for him.”

“I like what you’re doing with the imagery,” I say. “Where is your father? Is he still alive? Do you get to see him?”

“He lives in Michigan, somewhere. My aunt gave me his phone number once, but he never answers my calls. He’s messed up on drugs.” She scans the faces at the table.

“So why are you here?”

“Cutting, and running away,” she says.

“Let me see your arms.”

She pulls one sleeve of her hoodie up. She rolls her arm over, revealing hundreds of cuts—fresh and old. Some are scabbed over, some already scars she will live with the rest of her life.

“Who else cuts in here?”

All of them reveal their forearms. It’s as if they’ve survived a bus crash and every arm has traveled through shattered glass to be here. I look around the table at them.

“I cut my legs, too,” Emily says. “Want to see?” She raises her pant leg to reveal cuts all the way up her shin.

“Does that say hate?”

“Yeah, I was mad when I did that. It says lie over here, see?”

The following day, staff confiscates a screw from Emily. She’d worked for days to unscrew it from a cabinet that’s bolted to the wall in her room. No easy task. The head of every screw in the hospital takes a special tool to loosen or tighten it. Only the maintenance man could work these screws, or so we thought. But Emily shows staff where she got it. She says it took her days to unscrew it, like a prisoner of war, digging out inch by inch to freedom. Emily worked until it fell loose into her hands. She hid in her room, using the screw like a nine-inch nail. Then she passed the screw around to other cutters, as if it were a botle of wine. Their shared secret.

After discovering the screw, staff searches every room. Each room has two beds, two cabinets, two nightstands for their possessions, and one bathroom for every two rooms. There’s a mirror made from some type of reflective metal, a sink, a toilet, a shower—the bare necessities. We shake all the patients down. Go through every article of clothing. Overturn every bed. But there’s only the lone screw belonging to Emily.

The psychiatrist places Emily in the observation room and takes away all of her clothes. Dresses her in a sunshine yellow, paper gown. A staff person will sit in the doorway 24/7, to make sure her cuts won’t go deeper, and to let her know that her father is in Michigan, not deep within a cut on her body.

Emily’s isolation lasts for 24 hours. Now she’s sitting at my table in the classroom. The twenty-minute writing exercise is over, and Emily wants to read first. She holds up the picture she chose of a girl riding a large bird in flight.

She begins, “I’ve walked to the tracks before, so why is it so hard this time? Is it because I know I won’t be coming back? Last time, I sat and watched as each train sped by; watched as each chance for death passed...”

When she finishes, I say, “Wow! That was great.”

The other adolescents around the table agree.

I say, “What’s the inspiration behind it?”

“Before I came into the hospital, I ran away and walked to the train tracks behind our house, determined to throw myself in front of a train. But I couldn’t do it. I just sat there all night, it seemed, watching as each train passed, carrying with it my opportunity to die. The police found me walking through our neighborhood. Now I’m here,” she says, shrugging her shoulders.

“So the bird is the train?” I ask.

“Yeah, it takes me away from here.”

We sit in silence.

Emily will be discharged tomorrow. DHR hasn’t gathered enough evidence to remove her from the aunt’s home. The psychiatrist doesn’t want us to tell Emily she’s leaving until the moment her aunt walks into the lobby to retrieve her. He’s afraid she will react badly to the news, so Emily doesn’t have a clue she won’t see me again, that the train story will be her last. The aunt will come for her. She will wait in the lobby with the key to the padlock in her pocket. I wish I could say, “You’re leaving today, and I wish it were not so. But you take care. I will miss you. Keep writing.”

I wasn’t around when Emily was discharged. School was over. Later, I asked the nurse what happened. “Did she leave without fighting them?”

“She was crying,” the nurse said. “But she went without a fight.”

I can only imagine the ride home with the aunt. The yelling, the accusations, then the closing of her bedroom door, the snap of the padlock, the bucket on the floor, the lone train whistle in the distance.