probably armed, possibly not (repetition before and after volta)
pain itself, the image of agony
his bloody life in my bloody hands.
and the drink and the drugs won't flush him out
his bloodshadowstays on the street,
tosses his guts (disregard for human life, dehumanising image)
sort of inside out (hyperbole - not literal, unrecognisable as a human, brutality of war. violent image contrasted with the lack of identity he has been given - nameless, exaggerates war effects)