Both literal and metaphorical ghosts haunt the various characters, functioning as symbols of The Impact of Grief and Trauma on everyone involved in the war, soldiers and their families alike. Every soldier Laura meets in the hospital is haunted by at least one ghost, and even Pim, who maintains an air of cheerfulness until the end, is deeply traumatized by her losses. The novel makes it clear that no one escapes the trauma and ghosts of WWI.

Ghosts especially symbolize the inability of some characters to move past their grief and trauma. For instance, the Parkey sisters tell Laura that her ghosts—not only those of her parents but also those of the patients she has lost—trail behind her like “penitent-beads,” implying that she clings to her ghosts in a misguided need to punish herself for her perceived failures. She is unable to accept this, however, constantly insisting that she does not believe in ghosts and running when her mother’s ghost literally haunts her steps. Only when she finally confronts her ghosts face-to-face is she able to move forward. Similarly, Freddie submits to Faland’s control in a desperate attempt to run from his ghosts, especially the Canadian soldier he killed.