Addressed directly to the speaker's mother, the poem is a list of things a nineteen-year-old cannot say to her. He lives with depression and anxiety, a broken heart, loneliness, breakdowns in the school washroom, and nightmares, but each time he imagines telling her, something stops him. She dismisses his problems because he is young, doubts that he can cope with exams, and is too conservative to hear about a girl. Underneath it all sits his guilt: she nearly died giving birth to him, so how can he admit he wants to die?
The repeated "how do I tell you" makes the poem feel like a question he keeps circling without an answer. The mood is raw and heavy, yet tender. He doesn't blame her. He says she tries her best, loves him, and is still the person he thinks of when he cries. The ending is quietly devastating: she is the reason he stays, even on days he doesn't want to wake up.