“I want to play the piano.” she writes in the margin of her sheet music at the beginning of the fourth lesson after she is released from the hospital. I glance up at her from my metronome. Ticking ticking ticking. She looks down at her bow. Her positioning is seamless, holding the violin gently but firmly, her cheek resting on it thoughtfully.

“What about the violin?” I ask with my pencil. She looks at me in a way that ages her at least ten years, withering, I suppose I’d call it.

“Too easy to mess up.” She scratches next to my looping cursive. And with that I know that she will never play the violin again. That’s the problem with perfectionism, it kills you slowly, stealthily. Like cancer. She never used to be this perfect. She used to play with absentminded ideality. Every note she got wrong sounded better than anything she ever got right. Now she has to be perfect, and she messes everything up.

“Why is it so important that you get everything right?” I doodle. I regret it as soon as I see her knuckles turn white around the neck of her instrument.

“Dammit Karen you know why it’s important.” The pencil makes valleys in the crisp whiteness, bleeding gently into the lines reserved for musical notes. I don’t respond, and that only makes her angrier. She kicks the music stand like she wants to break its thin collapsible spine. Our conversation spills out on the floor. It’s true. I know why it’s important. For the same reason she refuses to talk with the tracheotomy microphone. For the same reason she wears scarves all the time now. We’re both just fifteen. We both never smoked a day in our lives. So why does she have to be the one with a hole in her neck?

She kicks the stand, anorexic metal tangling with soft flesh and bending to its force like clay. She dents it, stomping, but the violin remains unharmed. She could never bear to break the one thing she loves more than anything else in her life. She lays the violin‘s body delicately onto the table next to us and stomps over to the piano. She isn’t as good at playing the it as the violin, but it’s easier. You don’t have to regulate bow angle, you don’t have to measure every note against a mental tone machine. You just press down the keys, and perfect pitch is supplied. This used to be why she hated the piano. Now it’s the reason she needs it. She pushes down the keys and the notes fade into second hand sounds, vibrating into her bones. Infecting her like radiation and smoke. She closes her eyes, and I wonder if she’s going to cry. I’ve never seen her cry, even though I’ve been teaching her every week for five years, even though we spent most of those lessons less on playing and more on speculating about whether her parents were ever going to stop yelling at each other. Instead she angrily raises her fists and slams them down, creating a sudden burst of cacophony. It takes me a second to realize that she’s screaming.