“To Waken an Old Lady” is composed of 18 lines of verse not conforming to any metrical or syllabic pattern. As is often true of William Carlos Williams poems, the lines which comprise the poem are very small in length, ranging from two to six syllables in length and averaging somewhere around three or four syllables. Williams’s lines are not end-rhymed, nor do they employ much internal rhyme. Instead, Williams’s diction is minimal, vivid, clear, and precise. The poem is not divided into stanzas, but instead is made up of a single unbroken block of lineated text.

Some lines do utilize metrical effects to create musicality. For example, the couplet “Gaining and failing / they are buffeted” (Lines 7-8) is composed of lines which precisely echo one another’s meter. Each line is made up of one dactyl (or poetic foot consisting of one stressed syllable followed by two unstressed syllables) and a following trochee (or poetic foot made up of an initial stressed syllable finished by an unstressed syllable). The rhythm is clearly audible, with “GAINing and” echoing “THEY are buff” [emphasis added] (Lines 7-8) addended with their following “FAILing” and “FETed” [emphasis added] (Lines 7-8) clearly aligning with similar metrical structures.