The origin story for "My Cleveland Heart," Browne tells Rolling Stone, is this:
Browne first encountered the music to “My Cleveland Heart” after [Val] McCallum left a CD on his windshield with a note attached. After listening to it for months, Browne thought up an idea for the lyrics when he was driving around Cleveland, Ohio, and came across a building in the woods. “The person I was driving with said, ‘That’s Cleveland Heart,'” Browne tells Rolling Stone. “‘That’s where they make artificial hearts.’ I said, ‘Oh, I could use one of those!'”
Phoebe Bridgers makes an appearance in the video to eat Browne's "worn-out, useless heart" before he gets a new one.