“Here’s how it went in God’s heart: the six or seven or ten of us walked/wheeled in, grazed at a decrepit selection of cookies and lemonade, sat down in the Circle of Trust, and listened to Patrick recount for the thousandth time his depressingly miserable life story—how he had cancer in his balls and they thought he was going to die but he didn’t die and now here he is, a full-grown adult in a church basement in the 137th nicest city in America, divorced, addicted to video games, mostly friendless, eking out a meager living by exploiting his cancertastic past, slowly working towards a master’s degree that will not improve his career prospects, waiting, as we all do, for the sword of Damocles to give him the relief he escaped those many years ago when cancer took both of his nuts but spared what only the most generous soul would call his life.

“AND YOU TOO MIGHT BE SO LUCKY!”

This description of the Support Group and its leader, Patrick, is an introduction to Hazel and her cynical perspective on the culture of cancer survivorship. Hazel is unimpressed by the Support Group rhetoric that treats life and survival like a victory or a blessing, even when the circumstances of that life are clearly far from triumphant. Throughout the novel, Hazel will struggle to find a better reason to survive and to cherish survival for its own sake.

“They were close enough to me that I could hear the weird noises of their mouths together, and I could hear him saying, ‘Always,’ and her saying, ‘Always,’ in return. Suddenly standing next to me, Augustus half whispered, ‘They’re big believers in PDA [...] Always is their thing. They’ll always love each other and whatnot. I would conservatively estimate they have texted each other the word always four million times in the last year.’” 

Hazel watches Isaac and his girlfriend, Monica, kissing outside the Support Group. By saying “always” to each other, as a promise of undying love, they are enacting a ritual of teen romance that Hazel, with her shortened life expectancy, will never experience.

“‘They don’t kill you unless you light them,’ he said as Mom arrived at the curb. ‘And I’ve never lit one. It’s a metaphor, you see: You put the killing thing right between your teeth, but you don’t give it the power to do its killing.’”(

Augustus explains to Hazel why he habitually plays with unlit cigarettes. It is revealing of his cerebral, playful character, and of the way he regards mortality: as a cancer kid, the threat of death is extremely real to him, and impossible to ignore, but Augustus refuses to let this hamper or control him.