John Green, bestselling author of The Fault in Our Stars, makes reference to Esther Earl when showing the isolation of serious illness, "we have a habit of imagining the dying as fundamentally other from the well. We hold them up as heroes and imagine that they have reserves of strength forbidden to the rest of us. We tell ourselves that we will be inspired through the stories of their suffering – we will learn to be grateful for every day, or learn to be more empathetic, of whatever. These responses, while certainly well-intentioned, ultimately dehumanise the dying" So often, those with serious illnesses are isolated because of their conditions, as a society we place them on a pedestal as heroes to serve us as inspiration. In order to give those with serious illnesses back their humanity and to challenge our views towards them, Green uses symbolism in the form of cigarettes, a swing set and An Imperial Affliction to show how those with serious illnesses cannot be heroes for us to admire, they are not strong, super humans and they're lives are shrouded with pain and uncertainty. .
Augustus associates his cigarettes with taking control over his health, which is often out of his control, "they don't kill you unless you light them," he said as Mom arrived at the curb. "And I've never lit one. It's a metaphor, see: You put the killing thing right between your teeth, but you don't give it the power to do its killing." Cigarettes are a known carcinogen, by putting the killing thing in his mouth, but not lighting it, he gains a sense of control over his illness; he has control over its power, but not letting it kill him. So when Augustus becomes very sick and cannot get his cigarettes at the gas station, this is symbolisation of him losing control, he fails to get the cigarettes and therefore his sense of control is destroyed, this devastates him. Therefore as readers, when the cigarettes, which symbolise Augustus' strength, are unattainable by himself, we see how devastating his illness is.