Ella is a quiet portrait of someone in pain who hides it well. The girl in the poem takes a painkiller and drinks water, hoping the screams stuck in her head will fade once she lies down. The "screams" seem to be thoughts she can't silence rather than real sounds, and the pill suggests she is trying to numb something that a pill can't reach.
The images that follow are bleak. Her eyes are "so black" while her soul is "pale blue," a contrast between darkness and a faded, drained sadness. She is alone in the dark, and "not a single body knew," which stresses how invisible her suffering is. Even her smile is damaged: she "smiled, but ripped," as if the cheerful face is torn at the edges. The last line says she kept her wounds and "not ever lived," leaving a sense that she survived without really living. The subtitle, about a girl seen in the mirror, hints that the speaker may be looking at herself. The mood is lonely, heavy, and quietly desperate.