“But, in fact, depression is not a side effect of cancer. Depression is a side effect of dying. (Cancer is also a side effect of dying. Almost everything is, really.)”
Hazel offers this observation in Chapter 1 as she explains her understanding of what depression really is, challenging her mother’s belief that she needs treatment for it. She acknowledges her condition very matter-of-factly, a perspective which emphasizes the inevitability of suffering. Although she accepts her own suffering here, her ability to cope with the pain that others will inevitably experience in the wake of her death will serve as the central conflict for the narrative as a whole.
“I guess I had been looking toward the Encouragement above the TV, a drawing of an angel with the caption Without Pain, How Could We Know Joy?”
When Hazel goes to Augustus’s house for the first time in Chapter 2, she notices that his parents have inspiring quotes hanging in almost every room. This one in particular catches her eye, and while she initially mocks it, the idea that moments of pain add even more meaning to moments of joy becomes one that Hazel grapples with throughout the novel. She ultimately discovers that her love for Augustus is worth the heartache that his death causes, and this informs the way that she views the impact that her own death will one day have on others.
“You don’t get to choose if you get hurt in this world, old man, but you do have some say in who hurts you. I like my choices. I hope she likes hers.”
At the very end of the novel, Hazel discovers that Augustus wrote an obituary for her in his final days and concluded it with these lines. He ultimately argues that while suffering is inevitable, people can influence how they experience pain by choosing who they surround themselves with. Knowing that he impacted Hazel in a meaningful way gives him the strength to continue loving her despite the suffering that they will both endure upon his death.