Bitter thoughts, liver spots
Or bash your skull on river rocks
If you’re having bitter thoughts (going through bad times) your options are to either drink yourself into oblivion (ruining your liver) or just commit suicide (bash your skull on river rocks).
The other way to look at the first part of this verse is that liver spots are a sign of growing old. That would mean that this line is saying bitter thoughts are always present, and your options are to either grow old with them or end your life to get away from them.
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