The speaker is in pain and can't find a safe way to say it. Almost every line begins with "I don't know how to," and the repetition makes the speaker sound stuck, caught between needing help and fearing what asking for it will look like. Being honest feels "needy." Opening up feels like being "judged." Even crying hurts, since the tears feel "like acid."
The most striking image comes near the end, where words are "bleeding out of my mouth," waiting for someone to "stitch me up." Speaking becomes a wound rather than a relief. The speaker wants to be noticed without having to explain, yet admits that fixing them isn't the other person's job, and even says they'd be "better off" without them.
The mood is quiet, tired and raw. The final plea, to be seen "one last time," is ambiguous. It could mean a last attempt to reach out, or something darker, and the poem leaves that unsettling question open.