“You are a side effect,” Van Houten continued, “of an evolutionary process that cares little for individual lives. You are a failed experiment in mutation.”

Beyond serving as a reflection of Peter Van Houten’s aggressive character, these lines, which appear in Chapter 12, emphasize the randomness of cancer and the insensitivity inherent in that randomness. Van Houten’s scientific description of cancer removes any sense of humanity to reveal its highly impersonal nature, a quality which makes Hazel and Augustus’s cancer diagnoses seem immensely unfair. Their battles are merely the product of a meaningless and unpredictable universe, and this harsh reality causes Hazel to have a particularly nihilistic view of the world around her.

“I knew these people were genuinely sad, and that I wasn’t really mad at them. I was mad at the universe.”

Hazel offers this lament in Chapter 21 after reading online comments from those grieving Augustus’s death. With the news of his passing and her despair fresh in her mind, she is particularly attuned to just how unfair the world can be. The frustration she feels toward the plethora of comments from people who only knew Augustus on a surface level reflects her broader concerns over the pointlessness of both his death and eventually her own. She worries that the mourners will largely embody the universe’s sense of indifference towards them, rendering their lives rather insignificant. 

“I thought of my dad telling me that the universe wants to be noticed. But what we want is to be noticed by the universe, to have the universe give a shit what happens to us—not the collective idea of sentient live but each of us, as individuals.”

As she plays video games with Isaac in the aftermath of Augustus’s death, Hazel offers this assessment in Chapter 23 which essentially summarizes the novel’s entire argument about the inherent insensitivity of the universe. Contrary to her father’s belief that the world begs for attention, she suggests that humans want their individual lives to matter to the unforgiving universe. The random acts of suffering and injustice that occur to innocent people like Hazel imply that there is some truth to her observation. What she ultimately discovers, however, is that relationships with others can serve as a significant source of meaning in her life.