Few genres are more fascinating than true-crime books. My favorite examples of this type of book are the bizarre and gripping works of Janet Malcolm. Again and again, Malcolm has taken a case of criminal behavior and explored the characters from every angle; she has used moments of aberrant decision-making to unsettle us, to test our certainties, to make us think about what it means to be human.
The Good Nurse is far from the lofty plane occupied by Malcolm’s books. I suspected that it would be, even before I picked up a copy. Still, I wanted to know who this “good nurse” was, and how he had managed to get away with murdering up to 400 patients in his care.
Also, it should be noted that the publisher of The Good Nurse, Twelve Books, has produced one of the most enthralling works of true-crime reporting in the past several years—Dave Cullen’s Columbine. Given its success with Columbine, Twelve deserves a fair amount of attention whenever it publishes a true-crime book.
So: who is “the good nurse”?
He is Charlie Cullen, a man from a difficult household. As a child, Charlie was surrounded by many siblings, at least one of whom suffered abuse from a thuggish boyfriend. There were drugs in the house. One sibling appears to have committed suicide. Charlie’s mother died when Charlie was still quite young.
After his schooling, Charlie chose the nursing profession. He excelled. Unlike many nurses, he seemed to enjoy taking on extra hours, volunteering for weekend-, holiday-, and overnight shifts. He was punctual, tidy, and well-spoken. Female nurses seemed especially drawn to him, because he would tell charming, self-deprecating stories about his past. Charlie had a gift for inspiring warmth and pity in his female colleagues.
For a while, no one suspected that Charlie was secretly killing patients. He would spike hospital bags with insulin, digoxin, or one of a few other substances. Overwhelmed by a sudden rush of inappropriate drugs, a patient would mysteriously die. This phenomenon occurred over and over again. Eventually, Charlie’s employer would begin to suspect wrongdoing, and the employer would fire Charlie. No matter: hospitals are often in need of nurses, and Charlie had little trouble finding work. It seems that no hospital wished to report Charlie’s bad behavior, or at least to use official channels to make such a report. Hospitals worried about attracting negative publicity.
Skipping from employer to employer, sampling hospitals in Philadelphia and New Jersey, Charlie seemed immune from serious repercussions. A machine called a Pyxis would distribute drugs to nurses. Charlie simply keyed in the code for digoxin and stockpiled his wares. Sometimes, he would punch in his order, watch the tray pop open, then cancel the order and take the drug. An inspector would see the canceled order and assume that Charlie had not taken the drug. (However, you would not need to be a rocket scientist to note all of Charlie’s cancellations and conclude that something was not quite right.)
Charlie would also sometimes punch in an order for one drug, watch the tray pop open, then snatch out the neighboring drug (rather than the one he had requested).
How did all of this evil behavior finally come to light? Charlie was employed by a glittery superstar hospital, the Somerset facility in New Jersey. Somerset regularly did well in hospital rankings. (The author of The Good Nurse, Charles Graeber, quietly mocks hospitals, their rankings, and their desire for large profits. He observes that one hospital increased its revenue by building both a weight-loss treatment center and a 24-hour McDonald’s. Waist-trimming procedures and sleep-disorder treatments are major money-makers for hospitals.)
In any case, people at Somerset suspected that a nurse was killing patients, and they sent some of their questions to an independent investigator. The investigator quickly concluded that a nurse was, indeed, responsible for murder, and the investigator pressured Somerset to alert the proper authorities. Somerset demurred. Horrified, the independent investigator called the police.
It’s especially galling to read the parts of this book about Somerset. One hateful lady, Mary Lund, repeatedly lied and obstructed justice to protect her hospital’s reputation. Lund was a bureaucrat at Somerset, and she reminds me very strongly of Tilda Swinton’s heartless character in the film Michael Clayton. Amazingly, Lund and her hospital cronies were never prosecuted for their involvement in the Cullen murders. Lund should be behind bars. In a way, she is even less sympathetic than Cullen, for Cullen has the excuse of madness. You can find Lund easily on Google. Lund’s lack of a conscience, however, makes my blood boil.
The second half of the book mostly concerns the hunt for evidence. Two cops try desperately—with very little aid from the hospital, and sometimes with the burden created by the hospital’s lies—to link Charlie to the mysterious deaths. This second half has its own array of colorful characters, including Amy Loughren, a young hero. Though Amy feels some warmth toward Charlie, she agrees to wear a wire and coax a confession out of him. She risks her career and life to find the truth. In this way, she is a nice foil for the cowardly Lund.
Toward the end, you’ll also meet a woman named Roney, who struggles to assist Charlie in his wish to donate a kidney from jail. (Yes, Charlie gets caught.) Roney believes in Druidic rituals and feels convinced that Charlie’s kidney—“Satan’s kidney”, as it is labeled by the press—is meant to be transferred to an ailing man’s body.
In case it’s not evident, I really loved this book. The story is consistently incredible, but credit it you must, for it is the truth. Graeber’s many years of research have allowed him to narrate events clearly in great, sometimes horrific detail. I will not soon forget his harrowing descriptions of early-‘90s burn wards, where drugged patients had to be slit open and occasionally crammed into painful high-pressure healing suits.
Still, I have a few small complaints. It seems to me that Graeber could have painted a fuller picture of Charlie’s early life. Surely, there was evidence of madness in Charlie’s childhood. If there wasn’t any, then the fact of its absence deserves to be explored. Furthermore, I don’t fully understand the reason for Charlie’s confession. Given that this is the climax of the book—an end to Charlie’s many years of running and lying—it should be reported in greater depth.
Lastly, I object to the piety of Graeber’s acknowledgments. Here, he claims wistfully that Charlie, who has only wanted to disappear for the last few years, may now finally get his wish. Oh, please. Graeber must be aware that his book will not help Charlie to disappear; instead, it will drag Charlie back into the spotlight and generate more sensational headlines. (Graeber might have asked Charlie, if you truly wish to disappear, then why have you chosen to cooperate in my act of storytelling?)
…And when Graeber says that he hopes his work will help families of the victims of Charlie’s many killings to heal, I have to raise my eyebrows. It seems just as likely that these families will be wounded by the return of Charlie’s story to bookstands and newspapers. Graeber could have acknowledged this possibility in his notes.
Enough, enough. Small quibbles. I couldn’t put this book down, and I imagine that a large portion of America’s book-reading public will feel the same way.