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, the first of many operations to come. In time, the 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. 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. Their only hope was the knife and the pressure suit, a wetsuitlike garment that squeezes a child in a painful hug. The 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 to grow pliant. The child might one day move and grow. One day, maybe, they might even forget their pain. 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.
3
October 1987
Adrianne and Charlie Cullen took a mortgage on a small one-story in the steel suburbs of Phillipsburg, Pennsylvania. 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 was 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. But 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—and 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.
Charlie said that the puppy had run away. Or, that he assumed it ran away—he’d been out taking a walk while the baby was sleeping. Adrianne had to make him repeat that one—taking a walk, without the baby? Well, Charlie said, looking away. All he knew, he came back from his walk and the puppy was gone. He didn’t seem worried about it. He didn’t seem anything at all.
Adrianne didn’t understand—Charlie had left their infant daughter alone? And with the front door open? It wasn’t open, Charlie said, ajar, maybe, and anyway he knew the baby wouldn’t wake up. Adrianne didn’t like the way he said that. Knew. Had he given something to the baby? She’d had suspicions he gave their daughter cold medicine as a liquid babysitter; they’d had fights about it. He always denied it, and the discussion would go nowhere. Eventually, this argument went nowhere, too. Charlie simply stopped bothering trying to convince her of his side; he just let it drop and
disappeared back into the basement. Adrianne was left feeling crazy. She didn’t understand where the man she married had gone, or why he had lost interest in all but the most perfunctory duties of their relationship. Even when Charlie was physically home he was emotionally absent. She would catch his eye by the coffeemaker, study his expressionless morning face, and wonder if her husband was still somewhere in there, hiding like a child in a darkened room. He appeared to be permanently preoccupied, fixed upon some secret scene to which Adrianne’s every syllable was merely noise and distraction. Her friends told her to be strong. Her parents advised her that marriage was a marathon, not a sprint. He’s your husband, they reminded her. And so Adrianne chalked it up to the psychic demands of mediating life and death for an hourly wage. She went to work, paid the bills, took Shauna to day care, came home. Only the car in the driveway told her whether her husband was home. Charlie was spending most of his time in the basement. She’d tried going down there a few times. She was afraid to try again. Finding him in the half dark, she had seen something. Something disturbing about her husband’s eyes. Adrianne didn’t know quite how to describe it—a cool blankness, a look that belied any feelings of love she might have imagined her husband still harbored for her. Sometimes Charlie’s eyes would drift apart, watching two separate directions, as if each eye belonged to a separate being. In those moments, Charlie was not Charlie. Adrianne told her friends, “You know? I think maybe there’s something seriously wrong with Charlie.” Then one afternoon, proof arrived.
Adrianne answered the doorbell to find her neighbor crying. Every few weeks the neighbor’s sweet, ancient beagle, Queenie, would get out and wander down the block, and for some reason she usually ended up in the Cullens’ yard. Adrianne had brought old Queenie inside dozens of times. It got to be a sort of running joke, and when Queenie went missing, the neighbor came straight to them. But this time Queenie’s body was discovered in the alley next to their house. The vet said that she had been poisoned. Did Adrianne have any idea what might have happened?
Adrianne didn’t know what to say. She went inside to the kitchen, where the photos from PhotoMat lay on the counter, photos Adrianne had taken at day care, cute shots of Shauna with her little friends. Adrianne had come home a few days before to find that Charlie had taken a pair of scissors to each one, carefully cutting out the little boys like paper dolls in negative space. The pictures had frightened her, but she tried not to think about them. Now she couldn’t help it. The empty people shapes reminded her of her husband. She thought about the pictures and her puppy, about Queenie, and her neighbor crying at the front door. Then Adrianne started crying, too.
4
On February 11, 1991, pharmacy nurse Pam Allen had brought a suspicious IV bag to the desk of Saint Barnabas’s risk manager, Karen Seiden.1 The port on the bag looked used, but the bag itself was full to the point of leaking. It didn’t look right to Seiden, either. Seiden got in touch with the hospital’s assistant director of security, a former cop named Thomas Arnold. Arnold sent the IV bag to the pathology lab. The bag was supposed to contain only saline and heparin; the lab test found that it contained insulin as well.
Three days later, on Valentine’s Day, a Saint Barnabas Critical Care Unit patient named Anna Byers was placed on an IV drip of heparin. Within a half hour she was in a cold sweat, confused, nauseous, and shakingly weak. A blood lab showed an insulin level off the charts. She was given orange juice—a simple remedy of sugar and one of the fastest ways to normalize a crash if you catch it early enough. It didn’t work. The nurses were forced to give Byers an IV of dextrose, dripping sugar directly into her bloodstream. It kept Byers from dying, but she was so loaded with insulin that she crashed right through that as well. She stayed like that all morning, all afternoon, all night. Byers had a surgery scheduled for the next morning—a catheter was to be put in her heart. She was probably now too unstable to handle the procedure, but just in case, her physician ordered that her heparin IV drip be removed.2 As soon as Byers’s heparin drip was unplugged for surgery, her insulin issues abated, and she started to feel better.
By 2 p.m. she was back in her room, stable and well. Her blood sugar crash issues had vanished. Her surgical wounds were clotted. She was ready to be put back on the heparin drip. An IV was started. And soon after, Anna Byers was back on the same unstable ride again. By now her nurses were mainlining the sugar water, trying to outfeed the fire. She’d stabilize and crash, wooze in and out. By 11 p.m. there wasn’t enough sugar left in her blood to even get a reading. Her body had burned it all, leaving nothing for her brain. She was ready to code.
The nurses unhooked her IV lines and rushed her down to the ICU. But within twenty minutes of being off the drip, Anna Byers was feeling better again.
Down the hall, a patient named Fred Belf was on the same ride. His heparin went in at 7 a.m. By noon he was throwing up onto his own chest, unable to keep the orange juice down, and the doctors ordered him dextrose, to be delivered intravenously with his heparin. The two drips ran a race, side by side, one unhinging the other, all day and all night, like a metabolic teeter totter.
By 7 p.m. the next night, the connection had been made between the bags of heparin and the side effects on the floor. Belf’s nurses unhooked his heparin drip; Belf quickly began to feel better. Gloved nurses removed his IV bag, placed it in sterile plastic, and sent it for testing.
The bag came back positive for insulin. A microscopic analysis of the exterior revealed a peculiar landscape studded by tiny needle sticks, including three on the edges of the bag. This was extremely unusual. Bags of saline sometimes get stuck by needles in the course of being connected to the stopcock and, in turn, the patient, but they never get stuck on the perimeter. It didn’t look like an accident. It seemed possible that someone had been intentionally and repeatedly poisoning IV bags in the Saint Barnabas Hospital storage room. Arnold and Seiden had two bags as evidence, and the anecdotal examples of Byers and Belf. Now they dug back through the patient records in the CCU, to see if anyone else had experienced similar unexplained insulin crashes recently.
Though they had no causality, they discovered that patients were in fact crashing with regularity. For months, codes had become so frequent that they overlapped; the CCU nurses would need to leave one to attend another. The information was anecdotal and confusing—the incidents weren’t confined to any one unit, or any one shift. But across the intensive care, critical care, and cardiac units, Saint Barnabas patients were magically becoming instant diabetics.
Laboratory work3 showed that not only did all of the “magic diabetics” have exceptional and unprecedented levels of insulin in their bloodstream, but also that much of this insulin was “foreign”—it had not been produced by the body. The insulin had been given to them.
The first assumption was that a mistake had been made—a nurse misreading a doctor’s order, for instance, or a mislabeled vial. Such mistakes happen in hospitals all the time. Arnold and Seiden studied the patients’ charts but found neither a doctor’s prescription for insulin nor a nurse’s notation that it was given. This meant that either it was a double mistake—patients being given a nonprescribed drug, and the nurse then accidentally neglecting to complete the chart—or it wasn’t a mistake at all. Either way, they had a problem. Arnold took his findings to his boss, the head of Saint Barnabas security and SMBC vice president, Joe Barry.
In his previous life, Joe Barry had been a decorated and much respected thirty-year police veteran and former major with the New Jersey State Police. Now as senior vice president in charge of security at Saint Barnabas, Barry was charged with the delicate investigation into the potential murder of patients. With their combined experience, Arnold and Barry were uniquely qualified to conduct a sophisticated investigation such as this. After ruling out the patients’ own visitors, the only possible suspects left were the hospital staff. Arnold and Barry compared the nursing work schedules with the times and dates of the patient codes. Only three nurses wer
e working every code. And of these, nurse Charles Cullen interested them the most.4
Arnold had already interviewed several Saint Barnabas staffers about the insulin incidents.5 Each nurse had seemed nervous, concerned for her job and reputation and the patients involved. Only nurse Charles Cullen didn’t appear worried at all. In fact, he was pointedly not worried, about anything. To Arnold, it didn’t seem to just be a “Who, me?” act. Cullen genuinely didn’t seem to care. In fact, he was defiant. Arnold had tried several times to schedule Cullen for a sit-down meeting, but the nurse was employed by a staffing service, rather than the hospital. His shifts were erratic and varied, making Cullen difficult to pin down. When pressed, Cullen always made it clear that he was busy nursing, a responsibility “more important” than Arnold’s crass intrigues. When Arnold and Barry finally got Cullen into a conference room for the sit-down,6 the nurse refused to answer any questions. He sat there in the rolling chair, arms crossed, studying the linoleum. The attitude alone was a red flag to the ex-cops, and Arnold told him so.
“I know you’re putting something in those bags,” Arnold told him. He was shooting from the hip, he couldn’t prove anything, but his gut told him, absolutely, this guy was dirty. “You can’t prove anything” was Cullen’s reply. That struck the investigators as the wrong response for an innocent man—and not very smart, either. As former cops, Arnold and Barry read it as a fuck you. His defiance pissed Arnold off, made it personal. But Cullen didn’t seem to care about that, either. “I don’t need to talk to you,” he said, and walked out of the interview.
The Good Nurse: A True Story of Medicine, Madness, and Murder Page 2