The Fault in Our Stars (TFIOS) by John Green is also about teens who fall in love and who are actually dying because they both have cancer. The book is narrated from the perspective of Hazel Lancaster a teenage girl with stage IV thyroid cancer metastatic to the lungs. Hazel uses a nasal cannula connected to an oxygen tank because her “lungs suck at being lungs”.  

At the insistence of her parents she reluctantly attends a youth Cancer Support Group.  “Support Group featured a rotating cast of characters in various states of tumor-driven unwellness. Why did the cast rotate? A side effect of dying.” 

However things drastically change when a gorgeous boy named Augustus “Gus” Waters suddenly appears at support group.  Augustus Waters is seventeen, he has osteosarcoma and had part of a leg amputated. Gus and Hazel connect and the romance slowly blossoms.  

The book portrays the relationships of Hazel and Gus with each other, with their parents/family, healthcare professionals, healthy kids, and other “cancer kids” while they live their limited life the best they can.  It is clear how serious illness affects the already difficult teenage years. 

•  “There are a number of ways to establish someone's survival expectation without actually asking.  I used the classic "so are you in school?” Generally parents pull you out of school at some point if they expect you to bite in. “

•  “Cancer perks are the little things cancer kids get that regular kids don’t” Hazel 

•  “Depression is a side effect of dying.” Hazel

•  “That's the thing about pain...it demands to be felt.” Hazel 

•  “I already told you my story. I was diagnosed when-“  “No,  not your cancer story. Your story. Interests , hobbies, passions, weird fetiches, etcetera” 

•  “As he read, I fell in love the way you fall asleep: slowly, and then all at once,” Hazel

• 
  

  Okay

  “Oh, I wouldn't mind, Hazel Grace. It would be a privilege to have my heart broken by you.” Gus 

•  I'm in love with you, and I'm not in the business of denying myself the simple pleasure of saying true things. 

• “Maybe 'okay' will be our 'always” 

The 4 Questions:

"During your child's end-of-life care period, did you or a family member ever consider asking someone on the care team to give him/her or give you or the family member medications to intentionally end his/her life?”

"When your child was receiving end-of-life care, did you or a family member ever discuss intentionally ending his/her life?"

"Did you or a family member ask someone on your child's care team to give him/her medications or to give you or the family member medications to intentionally end his/her life?"

"Did a member of your child's care team give your child medications or did you or a family member give him/her medications to intentionally end his/her life?"

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19 (13%, about 1 in every 8) said they had thought about asking a doctor to hasten their child's death

13 (9%, almost 1 in every 10) actually discussed it with caregivers

5 (4%) explicitly asked a clinician for medications to end the child’s life

3 (2%) reported that their child’s life was intentionally ended with medication. In all three cases the medication used was morphine.

36% (49 of 136, about 1 in every 3) in retrospect, would have considered discussing HD under certain circumstances with a breakdown of scenarios given.

Uncontrollable pain was the most common circumstance to elicit a hypothetical consideration of HD. 15% would have considered HD for non-physical suffering.

Only 2 parents would have considered HD in circumstances not directly related to the child’s experience, (family witnessing suffering or medical costs).

94% endorsed proportionately intensive symptom management for a terminally ill child with uncontrolled excruciating pain, while only 54% did so in the case of coma; these results did not change when adjusting for race and religiousness.

50% (1 in every 2) endorsed HD in at least one vignette. 59% would agree with a physician discussing HD in the case of a child with terminal cancer in pain or coma.

Of the 19 who considered HD during their child’s EOL course 16 (84%) endorsed HD in vignettes.

In general, being white (not Hispanic) and being not very religious were associated with endorsing HD in vignettes.