Lyric discussion by shadowwiththeeyes 

Cover art for Shut the Door lyrics by Fugazi

I still think it's drugs. "break the surface" of his skin with a needle. "I tie my arms" --> tying off before shooting up. She's not breathing -- overdose. Even the paradoxes seem to reflect the paradox of freedom through drugs, which end up being their own prison. And that links back to the tortured way Ian yells "Have you ever been free?" in a way that makes it obvious he doesn't feel free at all. It's about a woman's overdose, and the last line is him trying to get away from it.