Course Hero. "The Fault in Our Stars Study Guide." Course Hero. 3 Oct. 2017. Web. 12 Dec. 2018. <https://www.coursehero.com/lit/The-Fault-in-Our-Stars/>.
Course Hero. (2017, October 3). The Fault in Our Stars Study Guide. In Course Hero. Retrieved December 12, 2018, from https://www.coursehero.com/lit/The-Fault-in-Our-Stars/
(Course Hero, 2017)
Course Hero. "The Fault in Our Stars Study Guide." October 3, 2017. Accessed December 12, 2018. https://www.coursehero.com/lit/The-Fault-in-Our-Stars/.
Course Hero, "The Fault in Our Stars Study Guide," October 3, 2017, accessed December 12, 2018, https://www.coursehero.com/lit/The-Fault-in-Our-Stars/.
Hazel awakens to excruciating pain and says she would have been happy to die; the pain is the result of her lungs filling with a liter and a half of fluid, cutting off oxygen circulation to her brain. She is rushed to the hospital where her lungs are drained and spends the next six days resting. For much of that time, Gus is at the hospital patiently waiting for her to agree to see him. On the last day she finally allows Gus to visit. He says the trip is still on as soon as she is better. She reminds him again that they can only be friends. He agrees and hands her a handwritten letter from Van Houten. The letter is a response to one Gus wrote to him saying while he is well, Hazel is sick and any love between them seems doomed. Van Houten agrees with Hazel's decision to avoid getting too close to Gus and keep their relationship platonic. After reading the letter, Hazel decides she definitely wants to go to Amsterdam with Gus, so she asks her mom to ask Dr. Maria if "international travel would kill" her.
The days in the hospital are filled with long stretches of sleep combined with pain. While her parents visit often, she does not allow Gus to visit because she doesn't want him to see her in such a weakened condition. He responds with maturity and a sense of humor. By giving Hazel the letter from Van Houten, Gus is showing her he really does understand her decision, or at the very least accepts it. After all, in the words of Van Houten, "the dead are visible only in the terrible lidless eye of memory. The living, thank heaven, retain the ability to surprise and to disappoint." However, the letter he hands Hazel implies he needed to ask Van Houten whether he should accept Hazel's decision not to become romantically involved with him. This was not a decision Augustus was able to come to himself and, in fact, by his persistence later in the novel, it is clear he is not persuaded to accept her decision.
The letter itself also provides insight into Van Houten's character. The first paragraph provides the quoted reference from Shakespeare's Julius Caesar that is the context for the title of the novel. From the outset, Van Houten bemoans the unfairness of fate and spends the entire second paragraph of the letter discussing how death, though inevitable, ultimately leads to "nothing" for both the person who has died as well as the person left alive. Van Houten recommends Augustus allow Hazel to spare him pain in part because, as we find out later, Van Houten's daughter's death left him in an immense amount of pain he was never able to fully recover from.