"
I hear the crowds beneath me
I'm wishing they could reach me
But I'm ‘on top of the world'
Up here I'm dying alone
I hear the crowds beneath me, I'm wishing they could reach me. This part means that he's over a crowd of people, and he's feeling isolated from them and wishes that he can join them or they can come to him. "But I'm on top of the world Up here I'm dying alone." This part is where powerful emotions are coming in at him. He's isolated more than ever and he feels like he's dying because he has no one to lean on. He's alone on top of the world as he slowly dies.