The speaker feels torn apart, caught "between the heart and head," and he is quarreling with something he made himself. This "creation" is described as a woman, both "sinister and righteous," who judges him for failing to live up to her hopes. It could be read as a real person, but the poem leaves it open. She might just as well be his conscience, his ideal self, or his own work, which now turns on him.
He insists he did what he could. Still, he can't give her the "peace and bliss" she wants, and she acts as though he caused all her sorrows. There's a sense of helpless guilt here, of being blamed for something he cannot fix.
In the last stanza he stands exposed and alone in the street, hands over his chest, waiting for a coffin. The mood is bleak and resigned. Only death, it seems, might settle truths he never managed to understand while alive.