Unsurprisingly for a novel about kids dying of cancer, suffering is a prominent part of the character’s lives. Hazel, Augustus, and Isaac all endure quite a bit of physical and emotional pain. The buildup of fluid in Hazel’s lungs deprives her of oxygen, leading to a bout of intense pain that lands her in the emergency room. Isaac has to contend with losing his remaining eye, which leaves him blind and leads his girlfriend to break up with him. Augustus physically deteriorates to the point that he has to take pain medication strong enough to leave him nearly incoherent, and he suffers to know he’ll never accomplish any of the heroic things he wanted to do in his life. In the eyes of the novels’s characters, specifically Hazel and Augustus, all these types of pain are simply a part of living, a side effect of it as Hazel might put it. That doesn’t mean they’re desirable, just that they’re inevitable.
But the most thematically significant type of pain in the novel is that caused by the death of a loved one, and it’s this variety that the novel suggests is the most necessary. Hazel worries a great deal about inflicting this kind of suffering on those around her when she dies, leading her to come up with the metaphor of the grenade that explodes and injures everyone nearby. It turns out she becomes the victim of this kind of pain when Augustus begins to weaken and finally succumbs to his cancer. What Hazel comes to understand is that this type of pain can’t be avoided. Since dying is certain and universal, all people will experience it. But as Hazel comes to recognize over the course of the novel, it isn’t necessarily something one should avoid. She wouldn’t take back the love she feels for Augustus for anything, even though that love is the precise cause of her pain. It’s a blessing and a curse, so to speak. The reason, as Augustus suggests in his letter to Van Houten that Hazel reads at the end of the novel, is that the pain you cause others when you die is a mark that you mattered. Augustus says happily that he left his “scar” on Hazel, meaning he hurt her but he also had an effect on her life that she’ll carry with her always. That type of pain, the novel suggests, is necessary, and in fact it’s a part of joy. Hazel touches on this idea in her eulogy for Augustus. The first thing she says to the gathered crowd is that there’s a quote hanging in Augustus’s that always gave the two of them comfort: “Without pain, we couldn’t know joy.”
The main characters in the novel are forced to confront death in a way that the young and healthy aren't. Although everyone will eventually die, as Hazel points out in Support Group, death's immediacy to the terminally ill means they can't avoid considering what comes after death, and the potential that all that's waiting for them is oblivion. It's a very present fear for Hazel and particularly for Augustus, and in fact it's the first thing they share when they meet at Support Group. Augustus, in response to Patrick's question about what he fears, replies right away with “oblivion,” and Hazel, who rarely ever speaks in the group, picks up immediately. She points out that everyone will some day die, which means everything humanity has ever built could all be for naught, and that just as there was a time before organisms experienced consciousness, there will be a time after as well. She says if the thought is disturbing one should just ignore it, but her tone implies that it's something that can't be ignored, at least not forever.
This theme carries throughout the novel. It's what motivates Augustus's desire to perform some heroic act before he dies and validate his significance. He worries that, without doing something dramatic that lives in people's minds after he's gone, he won't have mattered. His significance, like his consciousness, will simply be consumed by oblivion after his death. For Hazel, the fear of oblivion strikes her in a different way. She needs to know that those close to her, and her relationships with them, will carry on after her death. The comment she overheard her mother make that she'll no longer be a mother stays with her for this very reason, and it's also why she fixates on what happens to the characters in An Imperial Affliction after the protagonist, Anna, dies at the novel's close. She focuses on finding out what happens to Anna's mother and the Dutch Tulip Man, and even Sisyphus the Hamster, as a substitute for worrying about what will happen to her own parents after her death. When Van Houten tells her that the characters simply cease to exist the moment the novel ends, she tells him that it's impossible not to imagine a future for them. What she clearly means is that she has to believe that her own parents will continue on once she's gone, and that's why she's so greatly relieved to learn later that her mother has been taking classes to become a social worker.
What the novel ultimately suggests is that one person's death doesn't consign their significance and relationships to oblivion, and that what makes our lives matter are the relationships we form. As Augustus learns, his importance isn't defined by the fact that his life is temporary, because his importance to those around him will carry on. He leaves his “scar” on Hazel, as he puts it in the letter to Van Houten that Hazel reads at the close of the novel. Hazel, via a different route, discovers much the same. Her mother will continue to be her mother. Nothing, not even her death, can change that.
A refrain repeated throughout the novel is that the world is not a wish-granting factory. In other words, the things we want to come true often don't, and reality can be quite different from our fantasies. Numerous examples appear in the story. Isaac's girlfriend, Monica, breaks up with him just before he has his remaining eye removed, and despite his waiting and hoping, he never receives any word from her afterward. Augustus comes to realize that he will never perform some extraordinary feat of heroism. Hazel knows her lungs won't heal, and her death isn't far off. Peter Van Houten isn't so much the open, caring genius Hazel hopes, but a grouchy and malicious drunk. Augustus's story about his middle-school science teacher, Mr. Martinez, sums up the theme. As Augustus and Hazel fly back from Amsterdam, Augustus tells her he sometimes dreamed of living on a cloud, thinking it would be like an inflatable moonwalk machine. But he learned from Mr. Martinez that, at that altitude, the wind blows at one hundred and fifty miles per hour, the temperature is thirty below zero, and there's not enough oxygen for a person to survive. The man, he tells Hazel, specialized in the murder of dreams.
The theme underlies much of the novel's subject: teens dying of cancer for no justifiable reason. As Hazel and Van Houten both say at times, cancer is just a side effect of an evolutionary process. It isn't personal. It has no agenda, no feeling toward the person it's killing. This indifference is the reason Augustus finds no heroism in dying of it. It's just trying to be alive itself, and in fact it isn't some separate parasite: it's made of his own cells. That complete insensitivity is something Hazel also struggles with. After Augustus dies, she thinks of her father's earlier comment that the universe just wants to be noticed, and she reverses the phrase, saying what we want is to be noticed by the universe. The problem, as she puts it, is “the depraved meaninglessness of these things.” What her thought suggests is that some of things that happen to people, like developing cancer, occur at random, not with any maliciousness intended, but neither with any purpose. We want the universe to notice us, but it simply isn't aware. The title of the novel speaks to this idea. It comes from Shakespeare's “The Tragedy of Julius Caesar,” in which Cassius says, “Men at some times are masters of their fates: / The fault, dear Brutus, is not in our stars / But in ourselves.” The word stars here refers to fate. Hazel applies these lines to her own situation and concludes the opposite: the fault for their dying of cancer is not their doing but fate's.
The Fault in Our Stars takes joy in poking fun at clichés and baseless social conventions, especially regarding cancer kids and coming to terms with death. The novel seeks to downplay the popular idea that battling cancer is a noble, heroic, and rewarding act, and it does so primarily by showing the realities of cancer. There is nothing particularly noble for Hazel about struggling to breathe and knowing her death will hurt others, or anything heroic for Augustus in having had a leg amputated, or rewarding for Isaac about losing his vision. Instead the reader sees that kids with cancer are just that: kids. What makes them different from other kids is that they're put in the terrible position of having to deal with a debilitating and sometimes fatal illness. Augustus discusses this idea directly when he tells Hazel about his former girlfriend, Caroline Mathers. He talks about the trope of the cancer victim who heroically fights cancer until the end, then points out that kids with cancer aren't statistically anymore likely to be better people than kids without cancer. Caroline, he explains, became increasingly cruel toward him as her condition worsened. Rather than make her a better person, cancer made her worse.
The most poignant example of cancer's reality is Augustus himself after his cancer reappears. He withers quickly, and Hazel witnesses all the humiliation and pain he suffers as a result. He loses control of his body, urinates in his bed, and becomes confined to a wheelchair. When he calls her for help after driving to the gas station, she thinks of the person he's become, noting that the “Augustus Waters of the crooked smiles and unsmoked cigarettes was gone, replaced by this desperate humiliated creature sitting there beneath me.” A few lines later, she thinks of the conventions of the cancer kid, how they're supposed to maintain their humor and spirit through to the end. But Gus was the reality: suffering, frightened, and pitiful while struggling not to be. Through these details, the novel shows that the the false and feel-good conventions regarding cancer kids are really just hollow clichés used by society to deal with an uncomfortable subject.
The Author's Note refers to the idea that “made-up stories can matter” as “sort of the foundational assumption of our species,” and from that point forward the value of fiction is a prominent theme throughout The Fault In Our Stars. It turns up most prominently in Hazel's relationship with her favorite book, An Imperial Affliction. Hazel describes the book as her personal bible, as it's the only account she's read of dying from cancer that accurately matches her own experience. It offers her a sort of companionship, which comforts her. The question of whether or not fictional characters and a made-up story can have genuine value in a real person's life comes up when Peter Van Houten, the author of An Imperial Affliction, responds to one of Augustus's emails. Augustus told Van Houten the book meant something to him, to which Van Houten replies by wondering what value fiction really has. He suggests that it may offer the temporary illusion that life has meaning, when in fact it may not. He also wonders if fiction should act more like a call to arms, alerting people to things they should pay attention to, or a morphine drip, numbing them. But the Author's Note of The Fault In Our Stars offers John Green's answer, at least, to whether or not fiction has value. He believes it does, and the comfort, joy, and companionship Hazel finds from An Imperial Affliction in the novel similarly implies that made-up stories can be truly important.
For Hazel the idea of drowning resonates both on a literal and a metaphorical level, and it ties directly into novel’s most prominent symbol, water. On the literal side, the metastatic tumors in her lungs cause them to fill with fluid, which is the reason she's rushed to the intensive care unit midway through the novel. But drowning appears in other ways as well. When Hazel wakes one night with incredible pain in her head and has to go to the ICU, she describes it like being on the shore with waves crashing overhead, but being unable to drown. Drowning also appears in the T.S. Eliot poem “The Love Song of J. Alfred Prufrock” that Hazel recites parts of for Augustus. As they have their dinner and champagne in Amsterdam, she says the concluding lines of the poem: “We have lingered in the chambers of the sea / By sea-girls wreathed with seaweed red and brown / Till human voices wake us, and we drown.” She doesn't point it out at the time, but it's possible that the poem reminds her of her own situation. In these instances, drowning is a clear reference to the death Hazel fears, a threat she contends with constantly because of the tumors in her lungs. Finally, once Augustus dies, she uses the same analogy to describe how she feels having lost him. She compares it to being smashed by waves and unable to drown, meaning there’s no relief to her pain.
The characters in the novel, notably Augustus and Hazel, frequently use metaphors as a shorthand they can use to talk about emotionally overwhelming subjects. Augustus, for instance, describes shooting “existentially fraught” free throws on the day before the amputation of his leg. The free throws in this instance become a metaphor for Augustus's sense of purpose, since prior to his amputation he was an all-star basketball player, and losing his leg meant an end to sports. He suddenly began to question why this activity was so important, but the implication is that he suddenly began wondering what his purpose might be more broadly. He also fashions a symbol that is uniquely his own: He often keeps an unlit cigarette in his mouth in order to symbolize his control over a thing that can kill him, namely cancer. This is the exact form of control neither Augustus, nor Hazel, nor Isaac has when it comes to their cancers, and it's fitting that Augustus relies on the significance of the cigarette symbol to give him strength in times of fear and uncertainty. Hazel has her own frequently used metaphor. She likens herself to a grenade when she imagines the pain she will cause to her loved ones when she dies. In each instance the metaphor allows the character to deal with the subject at hand, Hazel's impending death for example, without having to call it by name.
Existentialism isn't so much a set of clearly defined principles as a convenient term for referring to a set of thinkers and artists, many with widely varying beliefs, who all examined how one can find meaning when life and death are potentially meaningless. This conundrum is precisely the one the novel's characters face. Frequently they question whether their lives have meaning if they die young of cancer, before having accomplished anything significant, and how they can then find meaning in their lives. In one notable episode, after Augustus dies Hazel thinks of her first encounter with him, when she said the problem of life isn’t that it leads to oblivion, but that there’s no evident meaning in that oblivion. Appropriately, then, there are recurring references to existentialist thoughts and thinkers throughout the novel, like the names of the rooms in the hotel in Amsterdam, which are all existential philosophers. The made-up novel An Imperial Affliction also ties into the motif as it raises questions about authenticity and value that were also concerns of existentialism. (See the entry in “Symbols” on An Imperial Affliction for a more detailed explanation.)
More significantly, existentialism comes up in the thoughts and fears of Hazel and particularly Augustus as they try to evaluate what meaning their lives have. Early on, for instance, Augustus refers to shooting “existentially fraught” free throws just before he had his leg amputated, and from what he tells Hazel it's clear that he was questioning his sense of purpose and meaning. Augustus eventually reveals that he wants to perform some heroic sacrifice, like diving on a grenade to save a group of kids as he does in the video game he plays with Isaac, in order to give his life and death meaning. When his cancer returns, he struggles with the realization that he'll never perform that kind of act, and Hazel's response is to marvel at Augustus's “existential curiosity.” Augustus is thus forced to wonder whether his life and death will be meaningful at all. Hazel takes offense to this questioning, arguing that an ordinary life without a heroic death, as hers will be, isn't necessarily without meaning, and Augustus comes to recognize that meaning is something he has to determine for himself. It’s a line of thought very much in keeping with existentialism.
Water in The Fault in Our Stars mostly directly represents suffering in both its negative and positive varieties. Water, for instance, symbolizes the fluid that collects in Hazel’s lungs as a result of her cancer. This liquid causes Hazel a huge amount of suffering in the novel. It forces her to use an oxygen tank, limits her ability to do any real strenuous activity, and it nearly kills her at one point. She likens the suffering she feels in that instance to being smashed by waves but unable to drown. (It’s no coincidence that drowning is one of the novel's major motifs, since water is, of course, at its center.) This type of suffering is obviously negative. At the same time, it's significant that Augustus's last name is Waters. He is Hazel's great love in the novel, and his physical deterioration and eventual death cause Hazel an intense amount of pain. Hazel, however, wouldn’t trade that pain for anything. It’s a mark of the love she feels for Augustus, which makes it a kind of positive pain. Hazel even uses the analogy of being smashed by waves but unable to drown again to describe the way she feels after Augustus dies. In doing so she creates a metaphor with two parallel sides: one where drowning in water represents the negative suffering of her cancer, and the other where drowning in water represents the positive suffering of her losing Augustus. Augustus sums up this dual nature of suffering, and water, in the final letter he writes to Van Houten. When he found out Hazel was hospitalized, he snuck into her room in the ICU and found her there unconscious. A nurse told him Hazel was “still taking on water.” Augustus describes this abundance of water to Van Houten as “A desert blessing, an ocean curse.”
It's also worth noting that the two locations in the novel, Indianapolis and Amsterdam, are canal cities. Amsterdam in particular is under constant threat of being inundated by the surrounding waters, like Hazel herself to some degree. It’s also home to Peter Van Houten, whom we learn is drowning, so to speak, in his own suffering over losing his daughter many years earlier to cancer. Finally, the book's epigraph, taken from the metanovel An Imperial Affliction, offers another layer of meaning to water’s symbolism. It refers to water as “conjoinder rejoinder poisoner concealer revelator,” giving it a nearly omnipotent quality, like a god, and compares water to time, both of which take everything with them in their tide.
The cigarettes Augustus often puts in his mouth but doesn't light represent his attempt to deal with and ideally control the things he fears. Though Augustus doesn't say so explicitly, the thing he fears most appears to be cancer. Cigarettes are a well-known carcinogen, and when Augustus explains the cigarette to Hazel it seems it's cancer specifically he is trying to control. Over the course of the novel, however, the cigarettes develop a greater meaning than August initially states. He reaches for them any time he feels insecure, suggesting they act as a symbolic way for him to control all his fears, with cancer just being the most notable. Toward the end of the novel, his incident at the gas station in which he has to call Hazel for help occurs because he's trying to buy cigarettes. In the context of their symbolic value, he is trying to regain control. By this point, his body is failing. He has difficulty walking on his own, he can't fully control his bladder, and when Hazel finds him in his car he's vomited all over himself. He says he just wanted to buy a pack of cigarettes on his own, and the state of his health and the fact that he was unable to get the cigarettes both point to the reality that any control he had over his cancer is gone.
The grenade metaphor signifies death and the suffering a person's death causes to those close to them. Hazel uses the term to describe herself after she reads Caroline Mathers's online profile and sees the effect Caroline's death had on others. She likens herself to a grenade that will one day explode, injuring everyone nearby. She also says Augustus becomes the grenade once his cancer returns and it's evident that he'll die before Hazel does. For Hazel, not hurting others is a major concern. It's evident in her being a vegetarian so that she doesn't add to the suffering in the world, for instance. Knowing the effect her death will have on Augustus and her parents therefore poses a serious conundrum for her. She doesn't want to keep them at a distance, but she feels doing so is the only way to keep them safe. The grenade symbol comes up again and again in this context as she wrestles with her desire to be close to them and her concern that she'll injure them.
But it's also worth noting that the grenade also turns up in the video game Augustus plays with Isaac. In the game, Augustus heroically throws himself on a grenade to save nearby school children in the game. It's only by sacrificing himself and willingly getting hurt by the grenade that Augustus, at least in the game, achieves the heroism he always desires, and in this regard the grenade metaphor ties directly into one of the major lessons in the book. After Augustus dies, Hazel reads a letter he sent to Van Houten in which Augustus discusses the idea of the people close to us hurting us. He says people don't get to choose who they hurt, but they can choose who hurts them. The grenade represents the suffering we cause others, but as Augustus shows in the game, in some cases the cause is worth it. Clearly we see that whatever pain Augustus's death causes Hazel was similarly worth it to her, and what the novel suggests through Augustus's act in the video game is that there's a measure of heroism in being willing to get hurt for the right cause.
An Imperial Affliction has an abundance of metaphorical resonance throughout The Fault in Our Stars. To begin with, it represents the healing value of fiction. Hazel refers to it as her personal bible because it's the only account of living with cancer she's found that corresponds to her own experience. That fact provides her with a great deal of comfort as she battles her illness, and it also establishes the foundation for the novel's other symbolic meaning: It represents Hazel's experience, and in particular her relation to her family. Hazel obsesses over the fates of the characters in the novel because they serve as proxies for her own parents, whom she wants to know will be alright after her death. By learning what happens to them and confirming that they don't simply disappear after Anna's death in the novel, she can feel certain that her parents will similarly live on after her death. The novel doesn't fully elaborate on the idea, but learning their fates might also be her way of confirming that Anna's story, and by extension her own, doesn't just end with her death. If the story continues, then even if Anna is no longer an active presence, she would still be connected to a larger saga that carries on after her passing. If that's true, Hazel could feel she similarly continues to play a part in the larger story of her family and friends, and that she doesn't simply disappear into oblivion with her death.
As a metanovel, or novel within the novel we're reading, An Imperial Affliction also represents the question of “What is authentic and valuable?” (This question ties in with the motif of existenstialism, since questioning authenticity and something's inherent value, say the value of life or morality for example, was a major theme of existentialism.) Questions about authenticity appear throughout the story, as Hazel deconstructs preconceived ideas about cancer patients for instance, but also regarding the authenticity of made-up stories. Starting with the epigraph, which is supposedly taken from the made-up An Imperial Affliction, the reader is forced to ask whether the fact that something is fiction has any bearing on its value.
For Hazel, the characters from An Imperial Affliction clearly hold a great deal of value to her, so much so that learning their fates after the end of the novel, as if they were real people, becomes an obsession. Van Houten, however, doesn't seem to believe much in the value of fiction. He questions its use in his email to Augustus, and he tells Hazel quite unapologetically that the characters simply cease to exist when the novel ends. In Hazel's mind that simply isn't true, and her questioning prompts the reader to ask the same questions about The Fault In Our Stars. If Hazel and Augustus are fictional, do they still have real value? The Author's Note suggests they do, saying that “the idea that made-up stories can matter” is “sort of the foundational assumption of our species.” An Imperial Affliction, therefore, becomes a symbol of the authenticity and value of made-up stories.
John Green has also published Looking For Alaska, Paper Towns, An Abundance of Katherines, Will Grayson, Will Grayson (with David Leviathan), and has worked on a number of short stories and anthologies, most notably This Is Not Tom and Let It Snow (with Maureen Johnson and Lauren Myracle).
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As a die-hard fan of John Green novels, I have read The Fault in Our Stars six times. Augustus Waters is actually seventeen, not sixteen.
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