In an interview with The New York Times, lead singer Gerard Way said, "At first I thought the patient died, but the more I think about it, the more I think he's not dead. Maybe this is all in his head. Maybe he can fight. Now I think he has a choice to live." The "Patient" is the main character of the album.
Gerard Way also said in an interview with Kerrang! magazine that the line, "I am not afraid to walk this world alone" played some part in the break up with his then girlfriend, known as "Katmandu."
The last lines of the song imply that the patient's lover is in fact the person who has died. "I see you lying next to me with words I thought I'd never speak" suggests that the Patient's lover is lying next to him in a coffin, as he speaks about her during the funeral service. The line "Awake and unafraid, asleep or dead" is further evidence that the Patient is alive and has entered into some new state of self-perception, that he has cleared himself of regrets. However there is no mention of the Patient's state; whether he has recovered from his illness or not. Though the song is named "Famous Last Words", that term is generally used when someone has died, and they have said their Famous Last Words.
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