Veterans of the war in Iraq experience effects that are not always obvious. Sometimes their problems are only visible to doctors like Natalie Mariano, who for the past five years has worked at the Veterans Affairs Primary Care Center in Hyannis, Mass.
I've never seen her smile, but today her face was soft and childlike, despite the wire rings piercing her eyebrows and lips.
She wore a white cotton tank top and baggy fatigues tucked into the tops of Army boots. Tattoos swirled up her arms, and images of thick black chains were wrapped around her neck.
"I'm applying for a scholarship to go back to school," she told me.
"That's great, Jade. What are you going to study?"
"Motorcycle mechanics," she said. "I'll be able to use my welding experience and not have to deal with cars. I could never work on cars."
After we talked about her plans for a while, she reached into an envelope and pulled out an application from the Registry of Motor Vehicles to renew her disabled parking sticker. She said, "I hate to have to do this again."
"It's OK," I told her. "You need to; it won't be forever." I turned Jade's form over and scanned the list of medical problems that the registry recognizes as reasons that qualify a driver for handicapped parking: heart or lung disease, the loss of a limb, severe arthritis. I looked up and down the list, thinking about Jade's disability.
"I hate having to use disabled parking," she said. "I see how people look at me, and I know what they're thinking. 'What makes that weirdo think she can park there?' Sometimes they ask me what I'm doing parked in one of those spaces."
"What do you tell them?" I asked.
"I just walk away," she said.
"Why don't you tell them the truth?" I asked. "Why don't you look them in the eye and say, 'I've had to park in handicapped spaces since I got back from Iraq, because now I can't walk past a row of cars without thinking that one of them is going to blow up in my face."
"Yeah," she said. "That's what I should tell them. Then I should shout that there's a bomb under one of those cars, and that it's going to go off and throw them across the road. That they're going to wake up and not remember what happened, until it all comes back, and then they're never going to stop remembering. That's what I should tell them."
I pushed the box of Kleenex toward her, and she wiped her eyes and nose. "I'm thinking of getting the tattoos removed from my neck," she said. "I can hide all the other ones, but I can't hide those, and when I go for interviews it might turn some people off."
"You're probably right," I told her. "I don't know much about removing tattoos, but we can look into it."
"It would probably leave scars," she said, "But that might be better. Maybe people need to see scars."
Dr. Natalie Mariano's story came to us from Atlantic Public Media in Woods Hole, Mass.