The overall pattern of O. Henry's short story "The Last Leaf" is the classical one of Freytag's Pyramid, which divides the story into five parts: exposition, rising action, climax, falling action, and resolution.

The exposition includes the introduction of Greenwich Village as an artistic neighborhood in New York City and of the artists Sue and Johnsy, who live there. The rising action consists of Johnsy contracting pneumonia, her loss of the will to live, her morbid fascination with the leaves falling from the ivy vine, and Mr. Behrman's reaction to her superstitious belief in her own death.

The climax of the story comes when Johnsy's observation of the last leaf tenaciously clinging to the vine makes her ashamed of giving up on life so easily and she decides to recover. The falling action consists of the doctor declaring Johnsy out of danger but telling her that there is another artist in the building who is dying of pneumonia. The resolution comes when it is revealed that Behrman painted the last leaf on the wall, saving Johnsy's life by sacrificing his own.

Apart from the overall pattern of Freytag's pyramid, there is an artistic symmetry in the story. The masterpiece that saves the life of its audience claims that of its creator, giving a fresh perspective on the idea of the artist dying for his art and a peculiar urgency to the viewer's appreciation.