The novel explores the causes and effects of PTSD through the characters of Jolene and Keith. Hannah uses Jolene’s experiences in Iraq to illustrate why veterans so often return home suffering from PTSD. Because the Iraq War lacks a traditional front line, there is no place of (relative) safety to retreat to. As a result, soldiers like Jolene and Keith live in constant fear: the “woman who smiles and waves can blow up the soldier who tries to help her across the street” (142). Compounding that baseline of danger, Jolene hears about and witnesses numerous helicopter accidents, which force her to face death much more viscerally than she ever has before. She and Tami realize they could die at any time, which shifts their outlook on life. Jolene exhibits this shift by having recurring nightmares about bombs, crashes, and dead bodies. After her helicopter crashes, she experiences these dreams even more often, to the point that she fears falling asleep. The stress of existing in constant danger and the trauma of witnessing violence and death combine to produce the complex set of symptoms known as PTSD.

Keith is the first character in the novel to exhibit PTSD. His story represents an extreme example of what can happen if symptoms of PTSD go untreated, but one with precedents in real life.