This long poem is divided into 48 segments, each a meditation on the narrator's struggle to live with emphysema. Some sections consist of only one line (10: "How alone can you get?"), others are more lengthy; for example, section 37 is a primer on inhalers, "puffers, " how to use them and what happens if you don't.

Every observation in this poem is from a literate poet's point of view, one here focused on emphysema, and so the breath, the body, and the daily rituals of living become primary. The whole world breathes--even the computer, which "sighs" when it is turned off (section 34)--but the poet cannot catch his breath. Reading the poem, even silently, the reader becomes short of breath too, physically aware of the patient's limitations.

In section 24, Carruth laments that he cannot even negotiate the 500 yards up hill to his son's house; in section 29, he writes that even the dog seems "reproachful" when his owner is unable "to play" and throw the blue ball. The accumulated limitations of these taken-for-granted actions makes the author both "pissed and sorry" for the dog, for the man, for the world.

In spite of the physical rebellion of the lungs, the narrator continues to smoke, as many patients with chronic obstructive pulmonary disease (COPD) do, adding another dimension to this poem. Even facing death, the patient's addiction to tobacco is overwhelming; in section 11, the narrator says, "Now I am dying. Now I am afraid. Please give me a cigarette." In section 45, Carruth laments this "nonsense of misery."