Coughing Up Blood is a visceral, gut-wrenching depiction of emotional and psychological agony by Micah Rose-Trespeuch. The language creates a vivid image of a maelstrom of internal conflict, drawing upon evocative imagery to explore the profundity of pain as well as healing. With harsh, vivid language, Micah describes feeling overwhelmed by emotion, hard to identify, let alone to let go of.

The song uses imagery of drifting in space to convey disorientation and isolation. Micah describes a feeling of illness, both physical and emotional, in a way that refuses to make sense. This feeling builds to a fever, a searing pain which seems to draw sustenance from a place deep inside. It’s not some huge, undifferentiated trauma that hurts, but a multitude of small, ordinary moments—memories, glances, words that stubbornly persist in his head and refuse to leave.

Micah frames silence as danger, not solace. Alone with his mind, he can feel his mental defenses begin to break. What then emerges from his is a feeling of helplessness as his feelings and thoughts rise to a point where they can no longer cope. Alone, vulnerable, and chilly, he clings as if it’s all working against his. The image of mental pain rising like a storm which rips through his mind is a great way to illustrate that it’s exhausting to deal with internal pain. The crying out, yelling reveals a desperate desire to grasp. Micah’s words tell us that though exhausted, pushed to his limits, there exists a corner of his soul that refuses to let go. That scream is defiance and release—a way to survive at a moment when everything else isn’t sane.

There’s also deep sadness in the way that he speaks about faking it. Laughing, smiling, and pretending with his friends is a way to hide what he wakes up to every morning. The fact that he’s okay with feeling drained, both emotionally and physically, allows his to relate to his lyrics in a way that’s more relatable to someone who’s tried to live despite feeling broken inside.

Micah begins to make a transition towards survival in the final section of the song. There’s no guarantee of peace, no quick solutions, but a gritty resolve to survive. He speaks of healing his own body and rinsing away pain, however ugly and brutal that’s to be. “Spitting up blood” becomes a symbol of living—painful, protracted, but human. The lyrics persist in your mind by virtue of their rawness and emotional pull.