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This ballad is about Cook's older brother Adam, who has been battling brain cancer. Cook told the Los Angeles Times November 18, 2008: "I purposely tried to be a storyteller on this particular song. I made it known what I was talking about. But it's still written in a way that people can take what they want out of it."
Cook recalled in the album's press release: "We recorded 'Permanent' in two takes and everyone in the room was crying. I actually had to leave at one point because it was so emotional. As a musician, any time you can create something where the end result is exactly what's in your head, well there's a heaviness to that moment and it overwhelmed me. I've been writing songs for ten years and that was the first time I'd felt it. I think there's an honesty throughout the record that culminates in that song."
This is one of four tracks on Cook's debut album to be co-written with his long-time idol Raine Maida of Our Lady Peace. Maida's singer-songwriter wife Chantal Kreviazuk also contributed to this tune.
David Cook performed this during the 2009 Grand Finale of American Idol, 18 days after Adam finally succumbed to his illness. A live version of the song was released digitally with all the proceeds going to the US-based non-profit organization Accelerate Brain Cancer Cure.
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