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Three days later, Augustus’s father phones Hazel. He says a notebook was discovered on the magazine rack near Augustus’s hospital bed. The pages in the notebook are blank, however the first three or four pages have been torn out. Wondering if Augustus might have hidden the pages in The Literal Heart of Jesus, Hazel fetches Isaac and they head to support group early. Unfortunately they don’t find anything. When the support group begins, Patrick asks how Hazel is doing. She says she wishes she would die. He asks why she doesn’t, to which Hazel responds that she doesn’t know. As Isaac talks Hazel thinks that she stays alive in order to notice the universe, and because she feels she owes a debt to everyone who isn’t a person anymore and to those who hadn’t gotten to be one yet.
When Hazel arrives back home, she wants to lie down but her mother tells her she has to eat to stay healthy. Hazel angrily tells her that she’s not healthy, that she’s dying and that one day her mother won’t be a mother anymore. Hazel’s mother, who didn’t realize Hazel overheard her say that, explains that she never meant it. She says she will always be Hazel’s mother, and she points out that Augustust’s death hasn’t caused Hazel to love him any less. Hazel confesses that she worries her parents won’t have a life after she dies, and her mother reveals that she’s been taking classes online to get her master’s degree in social work. She said she doesn’t want Hazel to think she’s been imagining a world without her, but if she gets her degree she can counsel other families. Hazel thinks the news is fantastic, and she begins crying out of happiness. As they watch America’s Next Top Model later, she asks if her parents will stay together after she dies. They say they will. Hazel manages to eat a few bites of pesto pasta.
The next morning Hazel wakes up panicked. In her dream she was alone and boatless in a large lake. Hazel gets a call from Kaitlyn. After talking a bit Kaitlyn suggests the torn out notebook pages might have been mailed to someone else. Hazel quickly emails Lidewij, hoping that Augustus might have sent the pages to Van Houten. Lidewij agrees to search for the pages at Van Houten’s in the morning.
While waiting to hear from Lidewij, Hazel thinks of the future she’ll never have. She comes to the conclusion that people are never satisfied by their dreams coming true, because there is always the thought that everything might be done better and again. Hazel’s mother interrupts her introspection to inform her that it’s Bastille Day, and they are going for a family picnic in Holliday Park. During the picnic Hazel considers the significance of the fake Roman ruins at the park. Though they were originally sculptural recreations, they are now old and ruined enough to be actual ruins. She imagines that Augustus and Van Houten would like the ruins. After their picnic Hazel and her parents visit Augustus’s grave.
That evening Hazel gets an email from Lidewij. She found the notebook pages. She forced Van Houten, who was very drunk, to read them, and when he finished he said: “Send it to the girl and tell her I have nothing to add.” Hazel opens the page files. She notices his handwriting varied a great deal, and she thinks Augustus must have written the pages over a period of several days, probably while experiencing varying levels of consciousness. The letter itself is a plea from Augustus, requesting that Van Houten utilize his superior literary skills to help him write a eulogy for Hazel. In the plea, Augustus says we all want to leave our mark on the world, him included, but these marks are really unpleasant scars. Hazel is different. She tries not to harm anyone or anything. The real heroes, he says, are the ones who notice things and pay attention. Augustus then describes seeing Hazel in the ICU after she was hospitalized and he found out his cancer had returned. He writes that we have no choice about whether or not we get hurt in the world, but you can choose who hurts you, and that Augustus likes his choice. He only hopes that Hazel likes hers. The final two words of the novel are from Hazel: “I do.”
The conclusion of the novel offers a concise look at how Hazel has changed over the course of the story. From the outside, the shift in Hazel’s character isn’t dramatic. She began the novel by attending the support group because she was depressed, and now we see her back in the support group and again depressed, albeit for a different reason. The difference is what Hazel has learned about suffering and love. The Hazel we initially meet thinks of herself as a source of pain for the people who love her, specifically her parents. She deliberately keeps her distance from new people and potential friends so they won’t be hurt by her when she dies. But Hazel’s relationship with Augustus has changed her way of thinking. She wouldn’t trade the pain of losing Augustus for the comfort of never having fallen in love with him, and that shift in her thinking allows her to see her parents’ situation differently. As her father has pointed out, the way Hazel feels about Augustus is the way Hazel’s parents feel about her: Whatever suffering they have to deal with because of her illness is outweighed by how much they love her, and they wouldn’t trade their time with her either.
The theme of the necessity of pain plays a significant role in the final section as well. In his letter to Van Houten, Augustus writes about the marks he says we all want to leave on the world, and they’re generally the things people do to prove they’re important in some way. It’s notable that he refers to these marks as “scars.” The term implies that a wound, and therefore pain, has been inflicted. While Augustus seems to think most of these scars are harmful, particularly those we inflict as a result of our own vanity, he makes it clear that not all are. The scar he left on Hazel is in this latter category. It’s proof that he mattered to her, that she loved him, and he’s happy he caused it. The type of pain that inflicts this scar is unique in Augustus’s mind. He says we can’t choose whether or not we get hurt, but we can choose who hurts us. In other words, we have no control over the pain we suffer, except in this one instance where we do control who inflicts pain on us. Those people, he suggests, are the people we love. His metaphor creates a direct link between pain and love.
Throughout the novel, Augustus has questioned the meaning and purpose of his life without any clear answers, but here he finally seems to draw a conclusion about what makes a life significant. Augustus’s main fear through most of the novel has been dying without having accomplished something meaningful, and he has always equated a meaningful life (and death) with doing something heroic that people will remember him by. That glory and fame, he thought, would be proof that he mattered. But in the letter to Van Houten that Hazel reads, Augustus appears to find a slightly different measure for proving he mattered and that his life had meaning. He refers to the marks we want to leave on the world to prove we’re significant as “scars,” and while Augustus seems to think most of the scars people leave, like mini-malls, are the wrong kind, he is happy about the scar he left on Hazel. He suggests that, because it resulted from their love for each other, it means he genuinely mattered, at least to her. It also satisfies his desire to be remembered after his death, as he knows Hazel will carry “his scar” with her always.
Hazel, meanwhile, comes to her own conclusions about her meaning and purpose in life. When Patrick asks her in Support Group why she doesn’t die, she actually stops to consider the question rather than just give her stock answer, which was that she went on living for her parents. But on thinking about it, Hazel, taking influence from what her father said about the universe wanting to be noticed, thinks that she wants to go on living in order to observe the universe. (The thought also recalls Augustus’s comment in his letter to Van Houten that the real heroes in the world are the people who notice things.) This change in her thinking seems to be the result of her relationship with Augustus. At the start of the novel, she didn’t seem to think much mattered, and her focus was primarily to avoid causing anymore suffering in the world. Now, however, she feels she owes a “debt” to all those who aren’t living, and the term indicates that she feels she has something of great value that they don’t: namely, life. What’s significant about this thought is that the Hazel we see at the start of the novel didn’t seem to think much of life’s value. She only came to see this value after Augustus greatly enriched her life, and sees her purpose as continuing on with her life, not to do anything extraordinary necessarily, but simply to use that life to notice what’s around her. Living, her thinking suggests, is its own purpose.
The dream Hazel briefly mentions about finding herself “boatless in a huge lake” ties into the water symbolism running throughout the novel, and its timing suggests a connection to Augustus’s death. Hazel has previously used drowning as a way to describe how she feels in particularly awful situations, like when she had to be hospitalized because of her lungs and after Augustus died. Here the threat she faces in being without a boat is again that she’ll drown. Moreover, water has been used as a symbol to represent pain, both psychic and physical. Augustus was Hazel’s refuge from this pain, but now she finds herself without him. Viewing the dream with this symbolism in mind, Hazel finds herself in danger of being overtaken by the pain she’s experiencing now that she’s lost Augustus, who is represented by the boat that Hazel finds herself without.
The final words of the novel, Hazel’s “I do,” are significant in a few ways. For a start, they mark the first and only instance of Hazel using the present tense during her narration the novel. This change in tense is notable because it indicates that Hazel currently loves Augustus. Her love hasn’t come and gone but persists in the present. The words are also a prominent feature of wedding vows, which are, in theory at least, supposed to bind two people together forever. Using those words suggests Hazel is entering into an agreement with Augustus to continue loving him into the future, and both meanings indicate that Hazel doesn’t see Augustus’s death as an end to their love for one another. The idea ties into the fear Hazel talks about with her mother, whom Hazel once overheard lamenting that she wouldn’t be a mother anymore after Hazel died. Through these scenarios, the novel suggests our relationships don’t end with death. Just as Hazel’s mother reassures her that she’ll still be her mother even after Hazel dies, Hazel acknowledges with her words that her relationship with Augustus will continue despite his passing.
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