Hazel is rushed to the hospital and wakes up in the ICU, where she is told that her lungs had been taking on fluid again, which starved her brain and body of oxygen. The fluid was drained, and the tumors on Hazel’s lungs have not grown, but she will need to sleep with a breathing machine known as a BiPAP. Hazel remains in the hospital for six days, during which she refuses to see Augustus. When he finally makes it in to visit her on the last day, she explains that she didn’t want him to see her disheveled and suffering.

During Hazel’s hospital stay, Augustus receives a letter from Peter Van Houten, who has been informed of their plans to visit him on a Genie-funded trip. Van Houten’s letter is cryptic and densely allusive, preoccupied with literature and death. Van Houten seems, in his letter, to support Hazel’s decision not to embark on a romantic relationship with Augustus because of the inevitable future heartbreak. Hazel is touched that her favorite author has taken an interest in her and Augustus, and pleads with her mother not to cancel the Amsterdam trip.