The next morning, Hazel wakes up in a panic because she had a dream in which she was without a boat and in the middle of a huge lake, surrounded by water. Her mother comes in with the phone, telling her Kaitlyn was on the other line. Kaitlyn apologizes to Hazel for her bad luck. Kaitlyn asks what it was like being in love with Augustus. Hazel tells her it was interesting. Hazel tells Kaitlyn he was not perfect. Kaitlyn asks if she has any letters from him. Hazel says no, but there may be some writing somewhere out there. When Hazel tells Kaitlyn about the missing pages, Kaitlyn suggests maybe they weren’t written for her, but sent to Van Houten. Hazel tells Kaitlyn she is a genius, and hangs up.
Hazel’s dream symbolically represents the way she feels about the loss of Augustus and the deterioration of her own health. Water is a symbol of her suffering, and the fact that there is no boat suggests that there is no escape from her suffering. When Hazel tells Kaitlyn that Augustus was not perfect, she avoids glorifying him because of his cancer, maintaining the fact that he was just a normal person—a normal person she loved—who happened to die of a common illness.
She writes an email to Lidewij, asking her if any writing from Augustus had arrived. Lidewij writes back, telling Hazel that she will be going to Van Houten’s house in the morning to look for the letter. She wonders why Augustus had written to Van Houten and not her before he died, but she figures he was asking Van Houten for a sequel. It makes sense to Hazel that he would use is terminality to make her dream come true.
Because Augustus was so intent on leaving behind a legacy and being a hero, it makes sense to Hazel that he would use his cancer as a way to get Van Houten to write a sequel. He used his dying wish to get Hazel to Amsterdam, but because it didn't come off well, it makes sense that he would continue on his mission.
As Hazel waits for Lidewij to respond, she thinks about Amsterdam and misses the future she knew she would never have with Augustus. She realizes she will never see the ocean again from an airplane, and that the ambitions of all humans are never satisfied by dreams coming true, because there are always thoughts that if might have been better and is possible to do over.
Hazel begins to realize the permanence of Augustus death as she misses the future she will never have with him. She also realizes that her own death will prevent her from experiencing many things. Yet her cancer and the impending death she faces also gives her clear-eyed insight.
While Hazel is pondering these ideas, Mrs. Lancaster comes into the room and tells her that it’s Bastille Day. She pulls two French flags from behind her back and begins waving them. Her mother tells her that she has scheduled a picnic with her and Mr. Lancaster.
Her family continues to celebrate obscure holidays, viewing them (like Hazel’s half birthdays) as an opportunity to celebrate with Hazel while she is still alive.
The day is beautiful, and Hazel and Mrs. Lancaster meet Mr. Lancaster at the park. They sit beside “the ruins”, a rectangular model of Roman ruins in the middle of the field. Hazel notes that the model ruins have been neglected, and have sense become actual ruins. She notes that Augustus and Van Houten would have liked them. Hazel hears the screams of children playing, and notes they are learning to live in a world not made for them. Her father asks her if she misses playing. She tells him sometimes she does, but she is more focused on noticing every little thing. As she watches, she suddenly thinks, “who am I to say that these things are not forever?”
The ruins suggest that sometimes representations of reality can assume their own sense of reality, which mirrors the fact that An Imperial Affliction represents Van Houten’s experience with his daughter’s death. Her comment about the children suggests that she still believes the universe is indifferent to humans, but her dedication to noticing the universe provides some meaning to her life. Her comment at the end suggests that she is open to other possibilities with regard to life and the universe.
After lunch they go visit Augustus’ grave. Hazel notes that she still doesn't feel like Augustus is present, but she takes a French flag and puts it in the ground at the foot of the grave. She thinks maybe passersby will think he was a member of the French Foreign Legion or some other heroic and important figure.
Hazel still does not feel any connection to Augustus in the afterlife, but she does put the flag in the ground in attempt to make him appear heroic, showing that his legacy is still important to her and she wants to be a part of sharing it while she is still alive.
That evening, Lidewij emails Hazel. She tells Hazel that they found a letter from Augustus, and she convinced Van Houten to read it by saying that he owed it to his daughter to read a letter from another dead child. Van Houten told Lidewij to send it to Hazel; he had nothing to add. Lidewij scanned and attached the letter in the email.
By not having anything to add, Van Houten—who in the past has always had some pretentious and cryptic thing to say—suggests that Augustus has said everything he needs to say on his own in his letter. Van Houten’s decision suggests he has had a change in perception about Augustus, Hazel, his daughter, and his resentment toward their cancer.
When Hazel opens the attachment, she realizes by Augustus’ handwriting and the changing color of the ink that he had written it over the course of several days in varying degrees of consciousness. The letter is from Augustus to Van Houten. In the letter he asks Van Houten to help him write a eulogy for Hazel. He writes that everyone wants to leave a mark on the world, but what bothers him is that he will be another unremembered person. But the problem with leaving a mark is that the marks humans leave are scars. In an attempt to survive our own deaths, we cause wreckage.
The fact that he wrote the letter despite his health stands as a true heroic act. Van Houten did not feel the need to help Augustus write Hazel’s eulogy, showing that he feels Augustus words are sufficient in telling Hazel how he feels about her. Augustus’ words suggest a change of heart during his death. He realizes that leaving a mark on the world out of vanity is actually a violent act, but some of these marks are unavoidable, and done out of love.
Augustus then writes that Hazel is different; she does not care about being remembered. What’s important is that she was loved deeply, and did little harm to other people. He thinks that Hazel is a hero because she notices things and pays attention to the universe. He reveals that he snuck into her room while she was in the hospital, and while there, he wished she would die before him so she wouldn't have to be harmed by knowing he was going to die, but his death had left a scar. He finishes by saying that you don't get to choose whether you get hurt in this world, but you do have some say in who you get hurt by. He says he is happy that he chose Hazel, and hopes that Hazel is happy too. The novel ends with her telling Augustus that she is happy with her choice.
Hazel is different than Augustus, as she does not care about being remembered. Augustus begins to realize that being loved deeply is more important that being loved widely. He suggests that pain is unavoidable in life, but a scar left by loving someone deeply is warranted, and necessary. His wish to leave a mark on the world is fulfilled because he left a mark on Hazel that she will carry forward, allowing him to live on after death. Through Augustus’ letter, Hazel is able to communicate with him after death and feel his presence, which is something she has been struggling with since his death. By telling him she is happy that he left a scar on her, shows that she recognizes the importance of pain in living life fully and her acceptance that those who love her will feel the same way about her as she does about Augustus.