In 2003, the world discovered what a night nurse named Charles Cullen had been doing for 16 years. He had killed a judge, a priest and an unknown but large number of others. He may have been the most prolific serial killer in history.
Though he had worked at nine hospitals in New Jersey and Pennsylvania, and some of his supervisors were aware of his dangerously unorthodox treatment of patients, he remained unnoticed. When his killings came to light, they revealed more about how the hospitals’ systemic and ethical failings had protected him than about Cullen himself.
Now Graeber has compiled the full Cullen story into “The Good Nurse,” a stunning book with a flat, uninflected title that should and does bring to mind “In Cold Blood.” “The Good Nurse” succeeds in being about much more than Cullen’s murderous kinks. The causes of his pathology are not interesting, but the eagerness of ambitious hospital administrators to cover up his misdeeds is revelatory, and the police investigation that brought him down is a thriller in every sense.
Cullen’s most compelling characteristics were a sophisticated knowledge of hospital protocols, an uncanny grasp of medical brinkmanship and an icy determination to game any institution foolish enough to take him in.
The first half of “The Good Nurse,” a litany of the crimes, is only a prelude. There’s a word or two about Cullen’s miserable childhood and penchant for suicide attempts, but the book soon moves on to the burn-unit training that may have shaped Cullen’s fatalism about patients fighting for their lives.
At first Cullen began tampering with the contents of IV bags. Insulin shock was one of his favorite outcomes, although he seems not to have paid much attention to what his victims actually experienced. Among the technically fascinating aspects of this story are the ways Cullen used hospital systems for browsing, keeping track of patients he had poisoned and picking challenging new targets.
Another is his command of the Pyxis automated dispensing system that gave him access to drugs. Before the system was upgraded, Cullen could order a deadly drug, remove it from the machine and then cancel the order. Eventually, when a nurse named Amy Loughren began monitoring her friend Charlie’s activities for Somerset County, N.J., detectives , she saw that he ordered and canceled drugs from the dispenser many times more often than an ordinary, lifesaving nurse would.
Graeber documents various hospitals’ efforts to know as little as possible about Cullen’s activities. At the risk of their patients’ lives, they did not want their institutional reputations damaged. But soon after Cullen started work at Somerset Medical Center in Somerville, N.J., Detective Sgt. Tim Braun and Detective Danny Baldwin took up the investigation. They were immediately struck by the paucity of records about Cullen and the eagerness of hospital lawyers to deflect them.
This hospital’s behavior (and that of others described) would be ludicrous if it did not involve patients’ deaths. The investigators were lied to so egregiously that they were told by a hospital “risk manager” that the Pyxis didn’t keep long-term records. But a call to the Pyxis’ manufacturer indicated otherwise. “Just pull it up,” Baldwin was told. “Is there something wrong with your machine?”
And so it goes, with sudden breakthroughs and eureka moments. A big one occurred when Loughren was told by a hospital official that she should deflect the detectives’ inquiries to a hospital lawyer.
“OK,” she told the detectives, hanging up the phone. “Turn on your tape recorder, boys, and tell me what you want to know.”