Accompanied by weeping guitar, this track finds Alsina working through personal disappointments as he sings of how he failed to buy his mother's affection and the hatred of his own family towards him. The New Orleans singer also reveals how he would lie in bed at night contemplating suicide.
Alsina borrows from the hook of The Isley Brothers' 1996 hit "Tears," when he sings in the pre-chorus:
I can't hold back these tears Let me cry They say a man ain't supposed to cry.
"Piano Man" was inspired by Billy Joel's time playing at a piano bar in Los Angeles. The "real estate novelist" was a guy who always talked about writing a book, but spent all his spare time in the bar.