The drowning motif and water symbolism appear again as Hazel suffers through a bout of severe, incapacitating head pain. The analogy she uses to describe the pain is quite apt. As she reminds herself that consciousness is temporary, suggesting she would like it to end, she compares the feeling to being pounded by waves on the shore but not being able to drown, since she remains conscious. In fact, as we learn, the cause of the pain is essentially drowning. Her lungs have filled with fluid, preventing her from taking in enough oxygen and resulting in the excruciating ache she feels in her head and, to a lesser degree, her shoulder. Because of her lung tumors, this way of dying is perhaps the main threat Hazel faces, and the imagery is well-crafted and appropriate in that regard. It skillfully ties together the drowning motif, the symbol of water, and evokes the feeling Hazel is experiencing.