In writing The Fault in Our Stars, novelist John Green tells a story of young love with no sense of futurity, no belief in a happily ever after. On top of that, Green rejects the sentimental clichés that tend to structure cancer narratives, about the nobility of suffering and struggle, and the redemption that validates pain and loss. The result is a novel where love is inextricably bound up with fear, death, and merciless physical pain—but is still, somehow, worthwhile.

Hazel Lancaster, age 16, and Augustus Waters, age 17, meet and fall in love at a support group for teens with cancer. Augustus, once a rising basketball star, has lost a leg to bone cancer, and Hazel carries an oxygen tank everywhere she goes because of thyroid cancer that has spread to her lungs. The two are attracted to each other immediately; they share a bright, restless intelligence and a skeptical view of the insipid platitudes that adults use to whitewash the horrible reality of their diseases. Augustus pursues Hazel determinedly from the beginning, but she is hesitant to begin a romantic relationship, despite being deeply attracted to him. Hazel’s cancer is terminal, and she doesn’t want to allow anyone besides her parents to become attached to her, knowing that they will suffer when she dies; “I’m a grenade,” she tells her mother one day (99).

Their relationship develops when they take a trip to Amsterdam, funded by the Genie Foundation, a fictional equivalent of the Make-A-Wish Foundation. Augustus, who qualifies for a wish through the loss of his leg, has arranged the trip so Hazel can meet her favorite author, Peter Van Houten; Van Houten has agreed by email to discuss his only book, An Imperial Affliction, with them in person. An Imperial Affliction is a sacred book to Hazel; she identifies with the heroine, Anna, who dies of leukemia, and is consumed with the desire to know what happens to the book’s other characters after it ends. In Amsterdam, Hazel and Augustus share a romantic evening together before a crushingly disappointing encounter with their literary idol. Van Houten is drunk and contemptuous; he refuses to answer Hazel’s questions about the characters and mocks her for asking them. They leave his house in disgust, and after a painstaking climb to the top of the Anne Frank House, Hazel impulsively kisses Augustus, and when they get back to the hotel, they have sex for the first time.

On their last day in Amsterdam, Augustus gives Hazel terrible news, which he has delayed telling her in order not to ruin their trip. His cancer has returned and spread throughout his body: he is not only sicker than she is, he is incurably, mortally ill. Hazel stays by his side as the cancer slowly, then more and more quickly, destroys Augustus physically, emotionally, and mentally. First he can no longer walk, and then he can no longer feed himself or control his bowels; finally he can barely stay awake or hold a conversation. As Hazel watches in despair, his intelligence, optimistic spirit, and eventually his sense of humor fade, too, under the strain of strong medication and stronger pain. He dies in the hospital about a month after they return from the Netherlands.

Hazel is overcome by grief but also strengthened by it. She realizes that the pain she once tried to save Augustus from—of loving someone only to lose them to cancer—is worth suffering for the experience of true love, and that their relationship was limited in time but limitless in depth of feeling. She gives a sentimental, hackneyed eulogy at his funeral, not because she believes in the cancer clichés now, but because they comfort his parents, and she faces life after Augustus more openly, eager to observe the universe.