On the birthday thing...none of our insiders have ever expressed that they have a birthday. And they don't really change ages, either, at least, they haven't so far. I think they're kind of frozen in time when the trauma happened, to be honest...except perhaps for the ones who age-slide.
Figuring out how to help Pamela communicate does sound like a very worthwhile avenue to go down. I can sympathize with the possible frustrations she might have, that she was trying to cut herself more than you. The hospital sounds like a REALLY frustrating place to be in, glad you got out of it!