The last thing April Quick said to her oldest child had something to do with potato skins. She didn’t know that would be their last conversation, of course, but it seems silly looking back on that day when everything happened.

That’s the way Quick prefers to talk about it:

“When everything happened.”

It was snowing, not long before eight that February night, and Quick was going to put some frozen potato skins in the oven for a snack. Ash Haffner, a 16-year-old high school sophomore — the child Quick brought into the world when she herself was in high school — didn’t want the potato skins because the snacks had onions on them. Ash hated onions.

So Ash went back upstairs to their third-floor bedroom in the family’s Union County home, and Quick ate the potato skins alone.

Ash’s room was typical for a teenager. Posters for Pink Floyd and Monster energy drinks and the Transformers movies were hung here and there. Ash had always been artsy, and one day had painted a two- or three-foot-tall flower blossom on the wall along with the words, “It’s not the petty imperfections that define us.”

Ash would stay up there for hours, chugging energy drinks and eating Nutter Butter cookies. The bedroom was Ash’s safe space, a place for scrolling through the internet and eating Chef Boyardee ravioli straight from the can, for carefully putting new stickers on the bottom of a skateboard and playing the guitar. It smelled like Axe body spray.

For nights on end, Ash had practiced singing a song called “Front Porch Step,” written and perfected while Quick slept downstairs. Ash’s laptop was filled with video clips, take after take after take, attempting to get the song just right. Ash, wearing a gray and black hoodie with bleached blonde hair swooped across the forehead in a skater style, looked into the GoPro camera and strummed the guitar strings.

“I’m so tired of the rain,” the song began, “falling softly on the ground.”

It was a love song, about broken hearts and unhealed wounds. It built to a crescendo. “Get off my mind, give back my heart, and get the f–k away from me.” Ash paused and gave a slight nod.

The video, and Ash’s other online postings, offered a glimpse at a teenager filled with angst, struggling for acceptance, trying to sort out a personal conflict about gender and sexual identity, battling mental illness. Like many adolescents, Ash was a prolific user of social media, especially Tumblr, where Ash posted funny cat videos and racy pictures of women in lingerie and a Taylor Swift song.

On Sunday, February 22, Ash linked to a quote.

“It’s sad to think that the majority of my teenage years were spent trying to survive than actually living,” it read.

Four days later, the snow fell and the potato skins came out of the oven and Ash went back to their room and shut the door. Ash sent text messages to friends. I’m done. I’m ready to die. Some of the recipients brushed off Ash’s declaration. Others said they’d check on Ash in an hour or two. Please call me, Ash typed. Ash left the iPad unlocked so their mom could find messages for friends and loved ones. And then, quietly, Ash snuck out of the house and into the wet winter darkness.

In the kitchen, Quick’s cell phone rang. It was one of Ash’s friends, who said she had received a worrisome message and maybe Quick should check to make sure everything was OK.

Quick thanked the teenager and ran upstairs, all the way to the closed bedroom door on the third floor. Nothing. She sent Ash a text. Nothing. She started toward the door but remembered it was snowing, and she needed to put some shoes on.

Meanwhile, Ash stood in the shadows along a two-lane road at the entrance to the subdivision, a block from home. When the headlights of a Jeep appeared, Ash stepped onto the asphalt.

Ash Haffner was one of dozens of North Carolina children who killed themselves in 2015.

The state will release an official tally later this month, but youth suicide is a growing concern for medical professionals, social workers, educators, and policymakers here. A state-funded Child Fatality Task Force has held hearings on the issue and is working with public- and private-sector groups to draft policy recommendations intended to combat an alarming uptick in child suicides this decade.

In 2014, 46 North Carolina children and teenagers died by suicide, up more than one-third from the previous year. And the number of youth suicides in North Carolina has doubled since the start of the decade, according to state-collected data. Youth suicide rates in this state are still roughly on par with national levels, but the 2014 spike in numbers, which is well above North Carolina’s historical average, caught the attention of public health experts.

“It’s a little early to call this a trend,” says Michelle Hughes, who co-chairs the task force’s Intentional Death Subcommittee. “We’d like to see several years of data before we call it a trend. But it’s worrisome.” Hughes runs NC Child, a nonprofit that lobbies the General Assembly on children’s issues. Of all the difficult issues she encounters — and there are plenty — suicide is especially confounding.

“This is something that is completely preventable,” she says. And yet, no one is quite sure what’s driving the increase. Hughes rattles off a list of contributing factors — mental illness, substance abuse, a history of trauma or child abuse, social and interpersonal conflicts, easy access to firearms and prescription drugs — but none rises to the top as the cause of North Carolina’s youth suicides. “There’s not really a consensus that there’s a single one that’s emerging as a driver for this increase. I think it’s the interplay of all of them.”

Every other year, the North Carolina Department of Public Instruction polls middle school and high school students across the state about risky behaviors. Last year, 9.3 percent of high schoolers who responded to the survey said they had attempted suicide. That number is up from 5.3 percent in 2013.

The statistics for middle school students — children between 11 and 13 years old — are even more alarming.

Ten percent of North Carolina middle schoolers who responded to the 2013 survey said they had attempted to kill themselves. If the survey was representative of the state’s public school population, that would mean nearly 70,000 North Carolina middle schoolers had attempted suicide.

“We are a little bit dumbfounded by that number,” says Ellen Essick, who oversees the survey for the NCDPI’s Healthy Schools division. The numbers reported by teenagers are higher that what emergency room doctors and parents report. “It would be an astronomical number if that were the case.”

And it’s not just children in North Carolina taking their own lives.

Suicide is the second leading cause of death for adolescents between the ages of 15 and 19, according to the American Academy of Pediatrics. The AAP says teenage boys are three times more likely to die by suicide than their female peers — but teen girls attempt suicide at twice the rate as males. Doctors say that’s because females tend to favor less lethal methods and don’t complete suicide as often as males.

After everything happened, April Quick went searching for answers.

She entered Ash’s room, still cluttered with aerosol cans of Axe and empty Monster containers, to look through Ash’s iPad and journals.

“if i die, i don’t want to be remembered as the sad person i am ok,” began a typed message on the iPad. “i don’t want to be remembered as the f—-t gay girl with all the scars on her arm.” Ash thanked her mom. “i may have come from a broken home but i always had a roof over my head and a loving mother who fully accepted me for who i was and never stopped trying.”

A few lines later, Ash tried to explain the reason for the note, the reason for ending their life.

“maybe i wasn’t meant to live a long time into a miserably handled life,” they wrote, “but to die early as a reminder that society is still f—-d up after all the deaths from suicide because of bullying or the scars on peoples arms.”

Quick knew about Ash’s struggle with gender identity, about the bullying, about the cutting. Even still, the note was illuminating.

“Everything started piecing together, making sense,” she says. “All the little things start seeming like big things and it’s like, ‘How did I miss that?’”

In 2013, the summer between eighth and ninth grades, Ash’s brown hair was cut short — like Justin Bieber’s, Ash would say — and told Quick about a girlfriend, another middle schooler who had started out as a friend and had become something more.  All three of them went to the mall together, the young couple holding hands, the mom trying to understand her child while letting Ash know there was no judgment.

But, of course, there was judgment.

Part of the way through her freshman year in high school, Ash identified as a boy on social media. Ash sent it to Quick. “I think there was a lot of rejection,” Quick says. “People don’t necessarily understand. I don’t think I understood a hundred percent.” But she said she still loved Ash and would respect the decision.

A few weeks later, Ash came back and said never mind, no need to call me your son. Ash was confused, and that confusion, compounded with Ash’s anxiety and depression, put Ash at risk.

“am i a thing?” Ash wrote in a journal entry around that time, blue ink on white notebook paper, the outward expression of so much internal strife. “‘he?’ ‘she?’ ‘it?’ ‘thing?’ im just as confused as you are. dont be so quick jumping to labels. my pronouns do not define me. but when you ask me if im a boy or a girl, i dont know how to answer. i havent identified my gender yet so just leave it alone and call me Ash.”

That’s around the time the cutting got worse.

Quick had noticed some superficial scratches on Ash’s arms, but they blamed them on the family cat. Nothing to worry about, Mom. And so Quick didn’t worry.

But she found iPhone photos Ash had taken of razor blade cuts — wounds that, paired with text messages Ash sent to friends, were clearly intentional. Quick talked about the self harm with Ash, and they agreed to start counseling, therapy, and outpatient treatment.

“It was the same — you know, the same cycle,” Quick says. Ash would have severe episodes of cutting and, occasionally, burning. They would agree to get help. Doctors would prescribe medication. Ash would commit to a treatment program. Progress. Safety. Happiness, maybe.

And then things would hit a snag.

Insurance wouldn’t cover a treatment, and Quick couldn’t afford it. The bullying would start up again. Programs would reject Ash for one reason or another. “Even in the months before when I knew things were getting bad,” Quick says, “you’re begging for help and nobody wants to listen to you.” She remembers one program accepted Ash, but put treatment on hold because there weren’t enough participants.

“It’s like, not enough participants? Is one child not enough? It could have been this one child that was saved,” she says. “At that point I didn’t know what more I could do. I was only able to do what I was offered, or what was approved. You can push, push, push, but if you’re told no or declined or rejected, there’s only so much you can do.”

Last year, a coalition of policy and health experts released the North Carolina Suicide Prevention Plan, 196 pages that seem to say there is plenty the state can do to prevent suicides.

The hefty report, developed by the Division of Public Health, Department of Health and Human Services, and UNC-Chapel Hill’s School of Global Public Health, is comprehensive. Its proposals for primary and secondary schools run seven pages, for example. They include things such as mandatory suicide prevention curricula for public schools, hosting health fairs, and collaborating with nonprofits on awareness initiatives.

But the report can be overwhelming for readers, even ones with political savvy. So the Child Fatality Task Force put together a group of experts and asked them to whittle the list down to a couple core priorities — things the task force can push to accomplish right now. Those recommendations will be released later this month, but insiders expect them to call for an increase in the availability of school counselors and nurses, as well as better suicide prevention training for school personnel.

“One of the tricky things on issues like this is there are lots of concerns and the hard part is prioritization,” says Kella Hatcher, the Child Fatality Task Force’s director. “There’s a lot of expertise and knowledge in this state, but moving things forward to action is always a challenge.”

Each year, the task force creates an action agenda to share with the governor and legislators. Hatcher expects suicide prevention measures to be on the list for next year’s General Assembly session. “It doesn’t just sit on a shelf,” she says of the task force’s report. “When you’ve got more than one group talking about an issue and saying it’s a concern and something we need to mobilize on, you can get some momentum.”

Quick moved into a new house earlier this year, and even though she knew it would sit empty, she set up a room for Ash. Before she moved, she had someone cut out the section of sheetrock — the section of the wall where Ash painted the flower — and move it to the new house. It leans against a wall, swaddled in bubble wrap. A collection of Axe spray cans is on one side of a black dresser. Ash’s skateboard, the one with the stickers on the bottom, is propped against a black futon.

Cardboard boxes sit in the hallway, labeled with black permanent marker: ASH CLOTHES. On top of that: ASH ROOM.

Downstairs, Quick has set up a memorial of sorts on a black cabinet — pictures of Ash, a candle, tributes made by friends. There’s a framed letter from President Obama, a response to a note Quick wrote the White House about bullying.

An empty Nutter Butter box is in the pantry. Quick couldn’t bring herself to throw it out, so she packed it up with the dishes and brought it to the new house.

She sits on the edge of a deep gold couch, across from a brown metal coffee table frame. The glass broke during the move and she hasn’t replaced it yet. The last year has been hard. “You feel like you’ve failed your child,” she says. “You feel like you could have done more.”

Quick has tried to push through, to keep from dwelling on all the little things that suddenly were big things. She’s poured over Ash’s belongings, posted tribute photos on Tumblr, and fielded questions — so many questions — from parents of kids who have attempted, and sometimes completed, suicide. They contact Quick because she seems so strong in interviews, because they believe she can help with their situation. They believe she has answers or advice. Something. Anything.

Those phone calls and emails make her the most uncomfortable. It’s easier to talk about the before-everything-happened Ash.

“Sometimes I wonder why these parents are reaching out to me,” she says. “My child took her life. I don’t feel like I have the right advice or the right answers.” As she speaks, she looks off to a spot somewhere in the next room, her voice barely audible.

“Everything I tried didn’t work.”

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Coming Tuesday: An elevated risk for suicide in LGBTQ youth.