Songfacts®:

• Jason Isbell told Uncut magazine about this defiant and intimate witnessing of a loved one dying of cancer, whose inspiration dates back to before he met his wife, songwriter/fiddler Amanda Shires: "I was living above this bar in Sheffield, Alabama, for a long time before I moved to Nashville with Amanda and I was dating this girl that worked at the bar," he recalled. "I told her she couldn't get too attached to the people sitting around the bar because they're all gonna disappear, and sure enough – within a couple of years, half the regulars were gone. It's hard for me to get through it some nights. It's a sad song."
  
  Isbell and Shires were married from 2013-2024.
• According to Patterson Hood of Drive-By Truckers, a group that Isbell departed in 2007, this is the "best song of 2013."
• "Elephant" topped Taste of Country's 2025 list of the most depressing country songs of all time. They said:
  
  "The song is extra impactful because its subject matter - cancer - touches so many lives, and so many listeners have experienced the futility of watching a loved one succumb to this terrible disease."