In the winter of Hazel Grace Lancaster’s seventeenth year, her mother asks her to go to a cancer support group because she believes Hazel is depressed about her cancer diagnosis. Hazel explains that depression is not a side effect of cancer, but a side effect of dying. Hazel explains that she has been staying in the house, spending a lot of time in bed, reading the same book, titled, An Imperial Affliction, and spending her free time thinking about death.
The novel begins with mention of Mrs. Lancaster’s concern for Hazel, establishing the importance of family in the novel. Hazel’s correction that depression is a side effect of dying shows that she is focused on her impending mortality. Unlike most teenagers, she stays in the house alone, thinking about dying, depicting the way in which cancer has denied her a normal teenage existence.
Hazel explains that the support group meets every Wednesday in the basement of an Episcopal church shaped like a cross. The group meets in a room where the two boards of the cross would meet. The leader of the group, Patrick, mentions that the group meets in the heart of Jesus, and how the young people, as cancer survivors, hold a special place in Jesus’ heart.
The support group meeting in a building the shape of a cross introduces the theme of religion. Patrick’s mention of cancer patients having a special place in Jesus’ heart speaks to one common view of young people living with cancer, but the reader finds out that this belief is often not sufficient for Hazel, who turns to philosophy to understand her illness.
During the support, they sit in the “Circle of trust,” and listen to Patrick tell his life story for the thousandth time, about the way his cancer had taken his testicles. Hazel speaks sarcastically about how Patrick tells the group he is grateful, although he has lost his wife, is addicted to videogames, is mostly friendless, and waiting for the “sword of Damocles” to fall down and end his life. After Patrick tells his story, the group goes around and introduces themselves: Name, age, and diagnosis. Then the group opens up for discussion. The only redeeming element of support group was a kid named Isaac. Isaac has lost an eye to cancer, and he has a glass eye in the place where the other eye had been removed. Isaac and hazel connect during the support group, communicating through sighs and sarcasm as they listen to the others share.
Hazel, and many of the other characters, find the support group emotionally and intellectually inauthentic. They are facing death in a very real way, which makes the simple platitudes of the support group seem phony. The irony in Patrick’s gratitude depicts this, and the “Sword of Damocles” reference suggests that even though he's in recovery, his death is imminent. Also, the fact that he has lost his testicles depicts the way in which the normal coming of age, which involves discovering one’s sexual drives, is disrupted by cancer. Hazel and Isaac bond through their sarcasm, showing the way in which being different provides opportunities for connection.
After going to the support group for a few weeks, Hazel comes to dread going. One Wednesday during a twelve-hour America’s Next Top Model marathon, Hazel attempts to get out of going to group. She argues with her mom. Mrs. Lancaster explains that she wants Hazel to make friends and be a normal teenager. Eventually, she agrees to go, not because she wants to, but because it makes her parents happy.
Hazel’s mother wants Hazel to have the opportunity to be a “normal teenager,” but Hazel knows she is not “normal”. She goes only to make her mother happy, which becomes a theme that continues through the novel.
When Hazel arrives at the support group, she notices a new attendee at the group staring at her as she gets a cup of lemonade. She looks away, suddenly aware of her oxygen tank, clothing, and puffy cheeks which are a side effect of her treatment. She takes a seat beside Isaac and admits to herself she thinks the boy is hot. The group starts, and Patrick leads the group in the serenity prayer, during which Hazel realizes the boy is still staring at her. She decides to stare back at him, and continues to stare until the boy looks away. She considers this a victory.
This scene is typical of coming of age narratives—two young lovers see each other for the first time, yet Hazel’s awareness of her oxygen and body suggests how she sees cancer as a barrier to such normality. The stare-down during the prayer suggests that the young people are more interested in (or distracted by) their blooming sexualities than religion. The feeling of victory Hazel gets by winning the stare-down shows that she is excited by this kind of attention, and it is new to her.
The young cancer survivors go around in a circle sharing about how they are doing. Isaac shares that he must go in for surgery and get his one remaining eye removed. He shares that his girlfriend, Monica, and his friend, Augustus are helping him through it. Other kids share around the circle until it gets to Augustus. He shares his full name is Augustus Waters, that he is seventeen, and had a “touch of osteosarcoma”, but is there to support Isaac.
Isaac’s confidence in Augustus and Monica to carry him through the loss of his sight shows the way in which these young people depend on each other. Augustus’ share reveals a lot about his character. He downplays his diagnosis, and will not say that he is there for support; he is there to give support. This foreshadows the heroism he wishes and strives for through the novel and his philosophies about life and death.
The group continues with the attendees sharing their battles and victories. Hazel equates this part of group to a circle jerk of support. Eventually, Patrick asks Augustus what his fears are. Augustus reveals that he is afraid of oblivion. Hazel, who shares she is not typically one to speak up, responds by telling Augustus that everyone will die, that “there was a time before consciousness and there will be a time after.” She suggests Augustus ignore it like everyone else. She shares that she had learned this from Peter Van Houten, the author of An Imperial Affliction, who is the only person she’s ever heard of who a) understands what it’s like to be dying and b) hasn't died.
Hazel’s sarcasm depicts the way she feels about the group. As typical with teenagers, she is resistant to the idea of sharing in a group, but beyond that, she actually finds the clichés and platitudes in conflict with her own experiences. Her response to Augustus’ fear of oblivion tells the reader something about her philosophy, which she has based on An Imperial Affliction. Her views are nihilistic. She believes life has no meaning and leads to death with nothing afterward.
At the end of the meeting, Patrick closes with a prayer in which he prays for all of the group’s attendees. At the end of the prayer he mentions the names of the group members who have died. Hazel keeps her eyes closed, thinking about the day her name will be added to the list of those who have died. At the end, Patrick recites the group’s mantra “Living our best life today.”
The names at the end of the prayer, and Hazel’s response to them shows that death is a reality for her. The presence of prayers and mantras at the end of the group shows how important religion and philosophy are to those who are dying.
After the mantra, Augustus approaches Hazel and asks what her name is. Isaac arrives and tells them about his trip to the doctor earlier that day. He told the doctor he would rather be deaf than blind, but the doctor told him his cancer didn't work that way. Isaac snidely tells them he thanked his doctor for telling him his eye cancer wouldn't make him deaf. Hazel facetiously says the doctor sounds like a winner, and tells Isaac that she is going to get some eye cancer so she can make the doctors acquaintance.
Isaac’s interaction with the doctor shows the way in which these young people have learned to interact with doctors. In the book, there are good doctors and nurses and bad ones, but the characters become skeptical of them, especially those who don't act kindly, compassionately, honestly, or with a little bit of humor. Hazel’s facetious response shows the way in which the characters connect through humor and use it to get through difficult situations.
After Isaac leaves to go meet his girlfriend Monica in the parking lot, Augustus turns to Hazel and says that they are “literally in the heart of Jesus”. Hazel jokes that it must be dangerous for Jesus to have cancer kids in his heart. Augustus stares at Hazel for a moment, shaking his head. When she asks what he is looking at, he says she is beautiful, and he likes looking at beautiful things. Augustus tells Hazel she looks like Natalie Portman in V for Vendetta. Hazel tells him she has never seen the movie. As they walk out, Augustus invites her to his house to watch it. She notices he is limping because his cancer took his leg, but he is confident nonetheless.
Hazel and Augustus’ comments show the way in which they find the group to be clichéd. They connect over humor, which establishes an interesting theme. The characters are often brought together by their illness, but quickly find other traits through which they connect. Augustus flirts with Hazel in a blatant way, showing that he has more experience than her and also attracted to her. She admires the fact that even though he has lost a leg, he is still confident.
In the parking lot outside, Hazel is surprised that her mother is not there yet. She sees Isaac aggressively kissing Monica against the wall and pawing at her breast. In between kissing, they say “always” to one another, which Augustus explains is there way of saying they will always love one another. Hazel wonders if his hand on her breast feels good, and forgives Isaac for the public display on account of his going blind. Hazel and Augustus joke about them, Augustus stating that it is difficult to tell whether he is trying to arouse her or complete a breast exam.
Hazel’s surprise at her mother’s absence shows her mother’s overprotective tendencies. The awkward kissing and touching between Isaac and Monica indicates that these characters are still inexperienced when it comes to their sexualities. Their promise of “always” also speaks to their naiveté as young lovers, foreshadowing the looming outcome of their relationship.
Just then, Augustus pulls out a cigarette and places it in his mouth. Hazel is taken aback by the cigarette and angrily accuses Augustus of ruining his chances with her. She says that there is always a hamartia (a fatal flaw), and of course Augustus’ has to be one that gives money to companies that profit through giving people cancer. She tells Augustus that not being able to breathe sucks, and she begins walking away angrily. Just as she begins to walk away, she feels Augustus’ hand grab hers. Augustus says that cigarettes can only kill you if you light them, and he has never lit one. He explains that the cigarettes are a metaphor: you put the thing between your teeth, but you don't give it the power to kill you. After explaining himself, Hazel agrees to go with him to his house.
Hazel’s response to Augustus’ cigarette shows the way in which she is insulted by the thought of a cancer survivor smoking. This response is interesting considering many young people are attracted to smoking when their peers do. Hazel, as someone living with cancer, knows the realities of smoking on a personal level, and this makes her different than many young people. Augustus’ explanation of the cigarette as a metaphor shows his desire for control. On the outside it appears he does have control, but the cigarettes also reveal his insecurities and fears of being out of control.