When asked about Earth Died Screaming in a interview, Tom Waits said:

“I think the world is going to be here a whole lot longer after we’re gone. I’m just waiting for the whole world to open up and swallow us all in, scrape us all off its back. I think the world is a living organism. When you stick a shovel in the ground, have you ever heard the earth go "Uhhgm?” And we’re living on the decomposed remains of our ancestors, both animal, mineral and vegetable. So it is a living thing. I don’t think it’s going to die screaming, I think we’re going to die screaming, in the swamp of time".

The song is essentially about the end of the world. By Tom Waits description, the song can be interpreted as the Earth taking revenge on us for “mistreating” it. But the song has biblical and fantastical references, leading to the conclusion that the world is ending as a result of the biblical apocalypse.

It can also be seen as a love song. While the world is ending, the narrator can only think about his beloved one.