My heart aches, and a drowsy numbness pains
         My sense, as though of hemlock I had drunk,
Or emptied some dull opiate to the drains
         One minute past, and Lethe-wards had sunk:
'Tis not through envy of thy happy lot,
         But being too happy in thine happiness

The speaker opens the poem with these lines (1–6), in which they set the stage for the poem by providing a sketch of their current mood. This mood is rather confused and admittedly contradictory: they’re at once numb and in pain, all the while heading “Lethe-wards,” which is to say moving toward a state of forgetful oblivion. Only in the fifth line does the speaker make their first reference to the nightingale and its song, through which the bird expresses its “happy lot.” The speaker claims not to feel envious of the nightingale’s joy. Instead, they claim that they feel “too happy in thine happiness.” Yet their use of the insistent phrase “too happy” arguably reveals a manic state of mind that is closer to anxiety than joy. The fact that the speaker isn’t entirely clear about how they feel gives us an indication of their confused and contradictory mood.

         Here, where men sit and hear each other groan;
Where palsy shakes a few, sad, last gray hairs,
         Where youth grows pale, and spectre-thin, and dies;
                Where but to think is to be full of sorrow
                        And leaden-eyed despairs,
         Where Beauty cannot keep her lustrous eyes,
                Or new Love pine at them beyond to-morrow.

In lines 24–30, the speaker reveals what’s truly troubling them. Up to this point in the poem they’ve remained vague about the source of their grief. Here, however, the speaker reflects explicitly on the pain and suffering that characterizes human life. They also lament the inevitability of decline and death, a thought that can’t help but produce “sorry / And leaden-eyed despairs.” It’s worth noting that Keats may be alluding in these lines to the loss of his younger brother Tom, who had died from tuberculosis not long before Keats wrote the poem. That said, it isn’t entirely clear whether the speaker has personally witnessed the suffering of others, or if they’re indulging in more abstract contemplation. Regardless, the speaker is clearly feeling anxious about mortality. The sheer fact that death is inevitable darkens the speaker’s experience of life. In a world defined by mortality, beauty will always fade, and love can never hope to survive “beyond to-morrow.” Note, here, how the capitalization of “Beauty” and “Love” quietly suggests personification. Poets often personify abstract concepts like these, and our speaker may have followed this tradition to bring a subtle degree of fantasy to their otherwise depressing ruminations.

                Now more than ever seems it rich to die,
         To cease upon the midnight with no pain,
                While thou art pouring forth thy soul abroad
                        In such an ecstasy!
         Still wouldst thou sing, and I have ears in vain—
                   To thy high requiem become a sod.

In lines 55–70, inspired by the nightingale’s song, the speaker finds a more balanced perspective on their mortality. Swept away by the nightingale’s song, which they associate with “the viewless wings of Poesy” (line 33), the speaker entertains the possibility that the experience of death might itself be “rich” and hence nothing to fear. Arguably, though, this moment of mental balance and clarity is based on a fantasy. After all, the speaker’s notion of a painless death relies on the presence of the nightingale and its song. Only through the accompaniment of this song can the speaker imagine reaching “such an ecstasy” that would allow them “to cease [living] upon the midnight with no pain.” This fantasy leads the speaker into a paradox. If they die while the nightingale is singing, then the bird’s song will effectively become a “high requiem”—that is, a song sung in honor of the dead. But because the speaker would be dead, they won’t actually hear this requiem. The pleasure they take is thus entirely anticipatory and cannot be fulfilled.

Forlorn! the very word is like a bell
         To toll me back from thee to my sole self!
Adieu! the fancy cannot cheat so well
         As she is fam'd to do, deceiving elf.

The speaker opens the final stanza with these fraught lines (71–74), which reflect the return of their anxiety as the nightingale takes wing, its beautiful song fading into the distance. The word “forlorn” is important here. The speaker has just closed the seventh stanza with this same word, while speculating that the nightingale’s song may be audible even in parallel realities, such as “in faery lands forlorn” (line 70). With the utterance of that last word, however, the speaker breaks their own spell. They liken this word to the tolling of a bell that calls them back to themself. If this word has the power to dissolve the speaker’s fantasy, it’s in large part because the word aptly describes the mood the speaker was in prior to the nightingale’s arrival. Indeed, to be forlorn is to be pitifully sad, abandoned, and lonely. Now, as the nightingale flies away, the speaker is once again forlorn. And with the spell broken, they reflect bitterly on their own capacity for self-deceit. Though briefly taken in by the transporting beauty of the nightingale’s song, the speaker now realizes that the consolation of “Poesy” (line 33) was little more than a “deceiving elf.”

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