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The Good Nurse
A True Story of Medicine, Madness, and Murder
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Edgar Award Nomination, Mystery Writers of America
BBC (Top Ten Books of the Year)
“The best books I read this year” (top ten books, EW)
“The Best Journalism of the Year.".
—The Daily Beast
“The most terrifying book published this year. It is also one of the most thoughtful…call it literary true crime…”
—Kirkus Reviews ("Best Books of the year")
After his December 2003 arrest, registered nurse Charlie Cullen was quickly dubbed "The Angel of Death" by the media. But Cullen was no mercy killer, nor was he a simple monster. He was a favorite son, a husband and beloved father, a best friend and a celebrated caregiver. Implicated in the deaths of as perhaps as many as 400 patients, he was also perhaps the most prolific serial killer in American history.
When, in March of 2006, Charles Cullen was marched from his final sentencing in an Allentown, Pennsylvania, courthouse into a waiting police van, it seemed certain that the chilling secrets of his life, career, and capture would disappear with him. Now, in a riveting piece of investigative journalism nearly ten years in the making, Charles Graeber gives us the unbelievable true story.
Based on hundreds of pages of previously unseen police records, wire-tap recordings and videotapes and interviews with whistleblowers and confidential informants, and years of exclusive jailhouse conversations with Cullen himself, the homicide detectives who worked against the clock and administrators to try and finally crack the code on Cullen’s crimes, and Cullen’s fellow nurse Amy, an overworked single mom asked to choose between protecting her friend Charlie and stopping a potential serial killer, THE GOOD NURSE weaves an urgent and terrifying tale of madness, humanity and heroism.
Cullen's murderous career in the world's most trusted profession spanned sixteen years and nine hospitals. Time and again he was fired or allowed to resign. But Cullen continued to work and kill, shielded by a hospital system that, by accident or design, successfully protected the institution while failing to protect patients. THE GOOD NURSE is a searing indictment of a crushing and dehumanizing for-profit medical system, and an inspiring human story of the previously unknown individuals who chose to risk their jobs and lives to do the right thing. Mesmerizing and irresistibly paced, this book will make you look at hospitals and the people who work in them in an entirely different way.
Table of Contents
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This is a true story built upon over six years of research and interviews with dozens of sources, including Charles Cullen.
Charlie is a proud and complicated man who, aside from our conversations, never issued a public statement or granted a single media interview. Our communication spanned several years, beginning with his attempt to donate a kidney from prison. He sees no reason to talk further.
His perspective appears throughout the book, but he is not the final arbiter of the facts herein.
Many other previously silent sources came forward to make this book possible. All risked their privacy, several risked careers or reputations. Some risked their freedom as well. Names and personal details have been altered when requested in order to protect their privacy and to shield those lives already altered by the events told here.
Every effort has been made to present this story accurately, through a relaying of the facts collected through police investigation reports, witness statements, transcripts, recorded wiretaps, surveillance tapes, court documents and legal depositions, and personal interviews. Some transcripts have been edited slightly for space and clarity, and some dialogue has been by necessity reconstructed based on corroborating documentation as above.
But as is true in any story of murder, the ultimate witnesses are voiceless. This book is dedicated to them, and to the good nurses everywhere who spend their lives caring for ours.
October 3, 2003
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, an 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 mistake1 that his working-class Irish-Catholic parents could hardly afford,2 arriving soon before his father died and long after most of his seven siblings had grown up and moved out. Their narrow wooden house in West Orange3 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 mission.
In March 1984,4 Charles Cullen was the only male student5 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.6 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 happy in the passive role of grudging candidate, and even happier when he won. Class president 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 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 Baum7 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 by the fixin's bar 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. 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. He needed her attentions and pushed for them every way he could, showering her with gifts and playing the model boyfriend for her family. Charlie obsessed on gaining her affection, and he kindled its flame with constant flowers or candy, little things from the mall. Any little thing Adrianne mentioned liking, Charlie needed to get her. 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 date8 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 prince9 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.
Saint Barnabas Medical Center had the only certified burn unit in the State of New Jersey, so it took everyone—the horrible husks of humans, people burned in car accidents, house fires, industrial spills; men and women and, most often, children, some burned to stubs, without hair or eyelids, their body surfaces cooked beyond repair. Charlie's job was to clean these burn victims on a metal gurney—to scrape and wash away the charred, necrotic skin with antibacterial soap and a brush. Even within the field of critical care medicine, this is an almost unimaginably gruesome procedure; as a first job straight out of nursing school, it's something close to hell.
All burns start with a story. A mother in a nightgown reaching for the teakettle,2 a paraplegic with a dropped cigarette, a drunk feeding a flagging campfire, the punctured gas tank of the crumpled car. Fire is the punch line. The body reacts predictably to the trauma. Third-degree burns are more deadly—complex layers of the skin, nerves, veins, arteries, and muscle cooked and dead—but second-degree burns are more painful because the nerves are still alive. Even in the 1980s, burn wards were scream wards. The drug of consolation was morphine. Some patients will recover; others are kept on the ward only to suffer and die. The nurses know which is which. Fate in the burn unit is a statistic written on skin. Sooner or later, all nurses can read it.
It's always the same drawing on the burn sheet, a human figure, bald and naked. It's ageless, sexless, hairless. Its toes point toward an unseen ground. Its arms stretch palms up in the universal expression of supplication and surrender. The figure's eyes are open and lidless, its lips full but without expression. You can tally damage in the figure precisely, marking the drawing for pieces of thigh, a half a leg, a piece of the head. The damage corresponds to a point system: One point for the genitals, 1.25 for each palm, etc. But there is an easier way.
The nurses call it the rule of 9s. Each big piece—a leg, the back, the head—counts as 9. Add up the total, then add that to the patient's age; the sum is the mortality rate. By this rule, a fifty-year-old patient burned over half his body is 100 percent dead. If not now, soon. The rule helps soften the blow of the inevitable, indicate where on the burn ward the meager rations of hope are best invested. Every burn nurse knows the rule, there's no point talking about it; you use the formula, then try to forget it. The impending death is like a black car you see in the rearview mirror, always there if you look. So why look?
Meanwhile the pain on the burn ward is unbearable, and the nurses have no options for treatment except to hit their patients with more and more morphine. When these patients die, it isn't always clear whether they've overdosed or simply died of unsustainable wounds. All anyone knows is they aren't in pain anymore.
The burn victims arrive at all hours. They may arrive in surprising ways, on stretchers or walking, alone or in packs. Sometimes they are lucid, talking, worried about their watch or a missed hair appointment. That's shock. Reality follows soon enough.
Burn victims are connected to machines, lines snaked into wrists and femoral arteries, plastic tubes shoehorned into holes top and bottom. Saline, electrolytes, pain meds, anxiety meds, liquefied food; the body swells with the fluids, sometimes doubling in size. The scrotum inflates like a beach ball, the eyes puff to slits, lips balloon and break like overcooked sausages. The body swells against the skin until the patient is as hard as carved marble. The blood vessels are squeezed shut. The core begins to die. And so they cut. It is simple surgeon's work. A blade runs the length of the arms and legs, front and back. Even the hands, puffed fat as udders, get cut. The knife runs tendon deep, five whisker-flicks beneath the knuckles like vents on a leather glove. The cuts3 allow space for the insides to expand, like pleats on pants, pressure sighing open along a sudden fault line, exposing canyon walls of yellow fat, a valley welling blood. The smell can be terrible, but the bleeding is a good thing. If it bleeds it is alive. But bleeding makes more work.
The pleated skin is loose, a greased shirtsleeve of leather, shocking to the touch. It takes time for nurses to acclimate to the point where they can effortlessly handle these tactile details of damage. When these details become too much, they leave. Some nurses leave the burn Intensive Care Unit right away, switch to something—anything—less brutal. Others stay only until they encounter the burn patient who reminds them, too much, of a loved one—or of themselves.
Nearly a third of the patients on the unit were children. Sometimes their burns were delivered as punishments, for peeing on a mattress or forgetting a chore. Nurses recognize the signs of abuse. There are burns from radiators and cigarettes, lighters and stove tops, red-hot water scalds and blackened electrical scorches. Each has its unique signature of pain. Charlie saw them all.
Some pain blossomed across skin in crenulated carnations of tissue, some blistered or knifed in thin white stalks. The nurses did their best to hide the pain beneath neat rows of gauze and tape, behind the mask of drugs. But Charlie knew that pain could be held in secret. Pain could be a banked ember, burning from the inside, endured without expression. Especially by children. Unlike adults, children didn't scream when he cleaned them, they didn't whimper in their beds. Children tolerated the pain and held their secrets to avoid being punished again. Charlie's mother had never used a stove top or a hot pan to punish him, but he'd been punished, pushed around, hit by his sister's boyfriends, big guys with rings and Camaros and bulging jeans. He'd felt their adult power, and he had never forgotten what it was to be a child abnegated in its shadow. One of his sisters had a live-in boyfriend, who had beaten her ruthlessly through her pregnancy. She had run away, but the boyfriend would not leave. And Charlie had known that man's relentless attentions, too.
He'd known pain in the military. Burns and punishment, too, for "damaging Navy property," as they put it, after he had woken up from a drunken shore leave with his bare feet sunburned red and as swollen as kickballs. They'd forced him into his dress shoes and gave him only aspirin. As he worked, he reminded himself that, yes, he knew a hurt far beyond what anyone could understand. Charlie dwelled on these kids in the ward in tremendous pain that no one could understand or properly address. At the time, nurses weren't allowed to give children any pain medications more powerful than Tylenol 3.4 It wasn't nearly enough. Many nurses wanted to give more. Some did.
The kids came in hot and rising, hurting and reminding Charlie of his own hurt, too. He would pick them up, these screaming, melted little people, knowing that later the surgeons would open each like a baked potato, a Y-cut to keep them from exploding, only the first of many operations to come. In time, their melted skin would heal into scars, vinelike ropes that the surgeons would cut again and again to prevent the neck from locking into an unbendable trunk, to keep the arms flexible. Without these operations, the children would remain stunted within their baked bodies. Their hard scar casings were too inflexible to accommodate growth spurts and normal movements. Their only hope was the knife and the pressure suit, a wetsuitlike garment that squeezes a child in a painful hug. The pressure suit presses against the scars, thinning them, like a constant rolling pin against the hard rising tissue. Maybe, with enough work, after time and pain and pressure, the scarred cocoon might thin enough. The child might one day move and grow. One day, maybe, they might even forget their pain. Charlie knew that the children might live, they might age in years, but not in body; without a nurse's intervention, they would be forever trapped within the groaning cocoon of their childhood. Charlie considered it one of the neater equations in life: the world pushed, and the pressure suit pushed back.
Charlie liked the Saint Barnabas job. He knew he was helpful there, needed. He enjoyed caring for the infirm, bathing and feeding and dressing the dependent. He appreciated the one-on-one of the night shift and the professionalism of his veteran coworkers. He even liked the name of the hospital; raised Catholic, Charlie was familiar with Saint Barnabas, an apostle. He had a personal connection with this particular saint. The church celebrates Barnabas's feast day every year on June 11. It was the day Charlie Cullen started working at Saint Barnabas Medical Center.5
In church on Sunday, Saint Barnabas was suspended in the archway of the stained glass window—bearded Barnabas, the handsome young companion to Luke and Paul, the Aramis6 of the early Christian Three Musketeers. As a Jew he had been Joseph, a landowner who sold his fields and gave cash to the apostles;7 as a convert, Saint Barnabas was an inspiration: Grant, O God, that we may follow the example of your faithful servant Barnabas, who, seeking not his own renown but the well-being of your church, gave generously of his life and substance…
But Charlie had no use for those sorts of prayers. In preparing to marry Adrianne he had formally renounced the religion of his upbringing and converted to Judaism. Charlie felt like he was living the life of the saint in reverse.
It never ends well for saints, no matter how good they are. Castration, defenestration, hot pincers, prison—the saint is a scapegoat, a martyr, a patsy. Barnabas was stoned to death,8 but his story lived beyond him. Every Catholic knew his name. It was the paradox of the saints, one thing Charlie held on to from his childhood: remembered well, remembered forever, but only after being hated to death.
Adrianne and Charlie Cullen took a mortgage on a small one-story in the steel suburbs of Phillipsburg, New Jersey. The house was cramped and dark and in need of paint. One side faced a billboardlike supporting wall, and the backyard bordered a weedy lot, but the price was within the range of their combined incomes. Adrianne had a new job as a computer programmer—entry level, but at least in a business office rather than a fast-food chain. Their reversed schedules, with her on long days and Charlie working long nights, surely contributed to Adrianne's sense of isolation, but that was only a piece of it. Increasingly, she felt alone, with or without Charlie.
Self-deprecating vulnerability had been part of the charm package Charlie had presented as a suitor. He was so forthright and often funny about his personal problems—particularly his history of depression and alcoholism—that Adrianne had quickly come to believe that she knew this man and, more important, that he knew himself. His perspective on himself made him seem not so much damaged as experienced, mature even. It gave Adrianne the illusion that Charlie was in full control of his demons; in fact, he was only now coming to know them. Adrianne sensed that a strange new chill had set into her life, an early autumn in their emotional life together. She chalked it up to the heart-rending nature of her husband's work and decided this was simply the lesson every medical spouse learns: love can't compete with death. She didn't imagine that her husband was drinking again.
Drinking had been the one aspect of naval tradition at which Charlie excelled. He drank to get drunk. He liked red wine, or tropical drinks—even Listerine, in a pinch—which had landed him repeatedly in the military's infirmary and psychiatric hospital, and introduced him to Antabuse and Alcoholics Anonymous. Adrianne had no experience with this side of her husband. She had never once seen him have a drink. When they were dating, he'd always said that he simply "couldn't." Adrianne considered his abstinence a sign of his conviction rather than a warning of his appetites. When Charlie had moved in to her apartment in Union, she even threw away the dusty bottle of Baileys Irish Cream she'd kept for fancy guests.
In Phillipsburg, Charlie kept his booze in his Navy footlocker, kept the footlocker in the boiler room, and kept a lock on the boiler room door. He drank alone in the basement, avoiding his wife. He liked it there. There was only one way in, nobody below, bedrock all around, always dark. The boiler room was a place to drink and think and watch the pilot light dance within its metal prison.
That first year of married life was a whirlwind. Charlie had been exceptionally busy. He'd received his New Jersey RN license a month after starting at Saint Barnabas, and a month later he started on another degree program at Kean College. Between school, work, and the commute, Charlie was seldom at home. Adrianne watched Dick Clark rock in the year 1988 alone with a minibottle of Chardonnay. By February she was pregnant. This was family life, the real thing, the point. But she felt her husband becoming increasingly cool with her, almost professional, as if she was one of his patients. Adrianne felt him cool down another click that fall, when their daughter Shauna1 was born. Now any attention Charlie had previously given his wife was shunted exclusively to the baby. Adrianne didn't understand the reaction—it was as if her husband had to choose between his wife and his child, as if he couldn't broaden the focus of his affections to cover them both. Charlie was overly enthusiastic about new things—their relationship, their house, their life—but as the novelty faded, so did his affect. She had seen him lose interest in a similar way with her dogs, first with her Yorkie, Lady. Adrianne adored Lady, and had believed at first that Charlie did, too. He petted her mechanically, groomed her little ears, watched intently as she gobbled her food. Then he seemed to change the channel, and the dog no longer interested him.
He was, however, interested in the new puppy—at least, Adrianne had thought so when they'd picked it out. This was her second Yorkie terrier, a companion for Lady. She had left for work Tuesday morning, leaving Charlie with the baby and the puppy, their usual changing of the guard on his day off. When Adrianne returned from work that evening, the puppy was gone. Charlie didn't seem to care, and he didn't want to help her look for it.
- "A stunning book...that should and does bring to mind In Cold Blood....the story appeals to prurient interests, as does any graphic tale of true crime. But THE GOOD NURSE succeeds in being about much more than Mr. 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 of that word."—Janet Maslin, New York Times
"The most terrifying book published this year. It is also one of the most thoughtful.... From a long series of conversations with Cullen, the detectives who solved the case and Amy, a nurse who once was Cullen's best friend and eventually got him to confess, among many other sources, Graeber has crafted a book that is a revelation. THE GOOD NURSE is gripping, sad, suspenseful, rhythmic and beautifully documented (the endnotes to this book are impressive)."
- "Graeber doesn't pull punches... A deeply unsettling addition to the true crime genre."—Publishers Weekly
- On Sale
- Apr 15, 2013
- Page Count
- 320 pages