The Good Nurse

A True Story of Medicine, Madness, and Murder

by Charles Graeber

Hardcover, 307 pages, Twelve Books, List Price: $16.86 | purchase

Purchase Featured Book

Title
The Good Nurse
Subtitle
A True Story of Medicine, Madness, and Murder
Author
Charles Graeber

Your purchase helps support NPR Programming. How?

Book Summary

An award-winning journalist describes the serial killer who was responsible for as many as 300 deaths during the 16 years he worked as a nurse and offers an inside look at the broken U.S. medical system that allowed this to happen.

Read an excerpt of this book

NPR stories about The Good Nurse

In a new book, Charles Graeber tells the story of Charlie Cullen, a registered nurse who was was dubbed "The Angel of Death" by the media after he was implicated in the deaths of as many as 300 patients. Twelve Books hide caption

itoggle caption Twelve Books

Note: Book excerpts are provided by the publisher and may contain language some find offensive.

Excerpt: The Good Nurse

Charlie considered himself lucky. The career had found him, by accident or fate he couldn't say. After sixteen years on the job, Charles Cullen was an accomplished veteran, a registered nurse with a GED and bachelor of science in nursing. His Advanced Cardiac Life Support (ACLS), Intra-Aortic Balloon Pump, and Critical Care Unit certifications earned him a healthy $27.50 an hour in hospitals across New Jersey and Pennsylvania. There was always work. Even within the rotted cores of Allentown or Newark, medical centers were still expanding profit centers, each proliferating with new specialties and services, and each locked in desperate competition to attract experienced RNs.

By 4:40 p.m., Charles Cullen was in his car, shaved, gelled, and dressed in his whites — white top and bottom with a soft yellow cardigan and a stethoscope draped across his neck, such that anybody might guess the handsome young man was a hospital professional, possibly even a doctor, despite his baby-blue Ford Escort station wagon, ten years old and freckled with rust. After a decade living in a basement apartment in New Jersey, Charlie's commute now started from across the border, in Bethlehem, Pennsylvania. His new girlfriend, Catherine, had a cozy little cape there, which she'd dress up with little card-shop knickknacks — red paper hearts or singing jack-o-lanterns or accordion turkeys, depending on the season — and though Charlie was growing bored with Catherine and her two teenage sons, he still liked being at her place okay, especially the little plot out back where he could putter on warm days, pinching deadheads or staking tomato plants. He also appreciated the five easy minutes it took to cross the Lehigh River to the familiar slipstream of I-78 East, the aortal artery pumping thousands of workers to shifts at labor-starved hospitals across the Garden State, only five or six of which were, unofficially, closed off to hiring him.

Over the course of his sixteen years, Charles Cullen had been the subject of dozens of complaints and disciplinary citations, and had endured four police investigations, two lie detector tests, perhaps twenty suicide attempts, and a lock-up, but none had blemished his professional record. He'd jumped from job to job at nine different hospitals and a nursing home, and been "let go," "terminated," or "asked to resign" at many of them. But both his Pennsylvania and New Jersey nursing licenses remained intact, and each time he filled out a new application, Nurse Cullen appeared to be an ideal hire. His attendance was perfect, his uniform pristine. He had experience in intensive care, critical care, cardiac care, ventilation, and burns. He medicated the living, was the first code responder when machines screamed over the dying, and exhibited origamilike artistry when plastic-wrapping the dead. He had no scheduling conflicts, didn't seem to attend movies or watch sports, and was willing, even eager, to work nights, weekends, and holidays. He no longer had the responsibilities of a wife nor custody of his two children, and his downtime was spent primarily on Cathy's couch flicking through channels; a last-second sick call or an unexpected patient transfer could have him dressed and on the highway before the commercial break. His fellow nurses considered him a gift from the scheduling gods, a hire almost too good to be true.

His new job at Somerset Medical Center took forty-five minutes each way, but Charlie didn't mind the drive. In fact, he required it. Charlie considered himself a talker, and he was quick to share cringingly intimate details of his showdowns with Cathy or his comically crumbling home life, but there were some privacies he could never talk about — secret scenes that looped through his head, replayed for him alone. Between shifts, only the commute allowed Charlie to ruminate.

His little Ford hiccupped as it crossed from the cheap Pennsylvania asphalt to the smooth New Jersey tar. Charlie stayed in the left lane until the signs for exit 18, a fierce little one-way toward US 22 Somerville and Rehill Avenue. This was the nice New Jersey, wealthiest state of the union, the Jersey nobody ever joked about — suburban streets, lined with grand trees, well-tended yards uncramped by abandoned bass boats or broken trampolines, pristine driveways featuring leased Saturns rather than old Escorts. He killed the engine in the parking garage, early as usual, and hurried toward the hospital's back entrance.

Beyond the double doors lay a thrumming twenty-four-hour city lit by humming overhead fluorescents, the only place Charlie ever truly knew he belonged. He felt a thrill of excitement as he stepped onto the shining linoleum, a wave of familiarity as he breathed in the scents of home: sweat and gauze and Betadine, the zing of astringent and antibacterial detergent and, behind it all, the florid note of human decay. He took the back stairs two at a time. There was work to do.

The nursing profession had welcomed Charlie as few other aspects of life ever had, starting with childhood. Charlie described it as "miserable." He'd been a late-life mistake that his working-class Irish-Catholic parents could hardly afford, arriving soon before his father died and long after most of his eight siblings had grown up and moved out. Their wooden row house in West Orange was a dark, unhappy, place haunted by drug-addicted brothers, adult sisters who drifted in and out on tides of pregnancy or need, and strange, rough men who came at all hours to visit them both. Only Charlie's mother shielded him from the chaos of those upstairs rooms. He fed desperately on her affections, but there were never enough to go around. When she was killed in a car crash during his senior year in high school, Charlie was truly alone. He was furious with the hospital that had taken her body, and beyond consolation. He tried suicide, then the Navy, failing at both. Finally, he returned to the very same hospital at which his mother had died, and discovered his life's true calling.

In March 1984, Charles Cullen was the only male student at the Mountainside Hospital School of Nursing in Montclair, New Jersey. He was bright and did well. The coursework suited him, as did the uniform, and the sisterly dynamic was familiar and comfortable. When the honorary class president dropped out two weeks into the first semester, one of Charlie's classmates insisted he run in her place. He was a natural choice for leadership, she told him: Charlie was bright, handsome, and, most important, male. Charlie was flattered, but running for president didn't sound much like him. The more he demurred, the more adamant she became. He wouldn't have to risk anything, she told him — she'd do it all. Charlie found himself surprisingly happy in the passive role of grudging candidate, and even happier when he won. It was only a symbolic position, but it seemed to signal the arrival of a new Charlie. Six years after losing his mother to the Mountainside hospital morgue, Charlie was Mountainside's chosen son, crowned and confirmed by a white-uniformed navy of professional nurturers. For the first time in his life, he was special. It was as close to love as Charlie could imagine.

Charlie paid for his schooling with anonymous franchise shift work, racking up hours pushing powdered donuts or shoveling piles of shaved meat. He restocked boxes or filled condiment bars and mopped floors in between — there was always mopping to be done. He found it ironic that, just as the recruiter had promised, his military experience so neatly translated into civilian skills. And just like the Navy, each of his civilian jobs required a uniform. For Dunkin' Donuts, it was the orange-and-brown shirt and a visor. For Caldor, the uniform was also orange and brown but the stripes were different. Charlie had to be careful to grab the right one from the pile from the floor. Roy Rogers required a rust-colored shirt seemingly designed to hide barbeque sauce the way casino carpets hide gum. It was a hideous garment, except when Charlie's manager, Adrianne, wore it. He especially liked the way her name tag hung.

Adrianne Baum was a different class of girl from the ones Charlie had known in West Orange, an ambitious, newly minted college grad with a business degree and student loans to pay. Charlie watched her, mooning over his mop handle as he worked cleanup in her West Orange Roy's location. But Adrianne had a boyfriend and was scheduled to be transferred. Charlie quit, and doubled his hours at the Caldor next door, but he still took his lunch breaks at Roy's, just in case. When Adrianne was transferred back a month later without the boyfriend, Charlie was there, waiting.

The relationship moved as quickly as Charlie could accelerate it. He needed her attentions and pushed for it every way he could, showering her with gifts and playing the model boyfriend for her family. Adrianne was surprised to discover that hidden inside the shy, wide-eyed boy she'd watched wiping the sauce station was a surprisingly confident man. Charlie obsessed on gaining her affection, and he kindled its flame with constant gifts, flowers, or candy, little things from the mall. Any little thing Adrianne mentioned liking, Charlie needed to get her, until Adrianne finally had to tell him to stop. She pretended to be annoyed — but really, how could she be? She was aware how many girls would have killed to take her place. The boy was a catch. That Charlie seemed to be constantly quitting or getting fired could be chalked up to his high standards and busy schedule. Adrianne told her girlfriends, wow, here was a guy working three jobs, president of his nursing school class, as serious about his career as she was about hers. Yes, so, he was a goy — he wasn't perfect. But he was close enough.

Soon, whatever spare time the young couple could winnow between their respective shifts and Charlie's schooling was spent together. They were a unit, complete but closed. They called it love, and six months after their first date they were engaged. They married the week after Charlie graduated nursing school. The rented hall in Livingston, the tuxedos, the honeymoon trip to Niagara Falls — it was like a fairy tale to Adrianne. They returned a day early so her prince could start on his new job in the Burn Unit at Saint Barnabas Medical Center in Livingston, New Jersey. The hospital was willing to allow him extra time, but Charlie was adamant. It had to be that day; he didn't want to be late. Adrianne waved good-bye, and she felt the future rolling out before her like a strange red carpet.