The dual nature of pain—that pain is, of course, awful, but that it can also be directly linked to joy—is a prominent theme in this section. This idea, which is a very important one in the novel as a whole, is the most significant part of Hazel’s eulogy for Augustus. While she doesn’t bother to describe the rest of her eulogy, she does mention a quote that’s hanging up in Augustus’s house which they both took comfort from, which implies that it’s particularly notable to her. The quote is “Without pain, we couldn’t know joy.” The underlying idea is that it’s the contrast between joy and pain that separates them and makes each one distinct. By bringing up the quote in her eulogy, Hazel suggests that the pain she and Augustus dealt with was worth it for the joy they experienced, and perhaps that the pain made their joy that much greater. Her father brings the notion up again when he says later that it’s bullshit that Augustus died but that it was a privilege for Hazel to love him. What he hints at is that the pain in such instances is more than justified by the joy it brings. It’s also significant that he tells Hazel that’s how he feels about her. Hazel worries a great deal about the pain she’ll cause her parents when she dies, but here he lets Hazel see things from his perspective. She immediately recognizes that, in the same way she wouldn’t give up what she had with Augustus even though his death hurt her, her parents wouldn’t give up their time with her. Finally she understands that she’s not a “grenade,” as she’s often put it, to her parents as she’s believed.

Hazel learns the reason for Van Houten’s unpleasantness as well as the genesis of An Imperial Affliction when he turns up in her car a few days after Augustus’s funeral. She also discovers why she seems to particularly bother him. Van Houten’s revelation that he lost his eight-year-old daughter from cancer many years earlier makes a number of things much clearer. First, it’s suddenly clear why he’s so disagreeable, and drunk, most of the time. He’s very obviously never recovered from her death, and in the same way that Augustus’s illness caused Hazel to lash out at others, he similarly lashes out. Second, as Hazel realizes, An Imperial Affliction essentially served as a way for him to give his daughter the chance she never had to be a teenager. It makes sense, then, that the novel comes across as extremely accurate and honest to Hazel. Although Van Houten’s daughter never lived to be a teenager, as Anna is in the novel, Van Houten and his daughter still experienced all the suffering and loss that come with terminal cancer. It’s for this reason that Van Houten was able to convey those emotions so clearly in the novel. Lastly, it’s also evident why Hazel seems to draw Van Houten’s ire more than anyone: She reminds him of the fictional teenage daughter he created. When Hazel first met Van Houten in Amsterdam, she was even dressed as Anna dresses in An Imperial Affliction. Hazel is a reminder to Van Houten of everything he suffered and of his loss.