The Good Nurse: A True Story of Medicine, Madness, and Murder

by Charles Graeber

  This was him, an earnest health-care professional, lovesick and concerned, the sort of foolish heart who had told the policeman that he’d drive right over and did just that, on time. He figured that later, when the pills kicked in, he’d be Romeo, overwhelmed with love and poison, right on stage.

  The drugs worked as planned. Xanax is a fast-acting antianxiety drug and kicked in first, delivering wave upon wave of So What while his wife’s opiates put a little gravity in his feet. Charlie answered the policeman’s questions, feeling high and loose. He offered his fingers, and the sergeant rolled each on an ink pad, then onto a corresponding square. They took his picture and sat him at a desk with a typewriter. But the Palmer police had no intention of holding Charlie in a jail cell. A complaint had been filed, and they had his address and number. They knew where to find him if he failed to show up for his court date.

  Charlie was almost floppy by the time they released him back into the parking lot. The late winter sun was almost gone now, and a cold rain fell from a dirty nickel sky. He found his keys, sat in the driver’s seat, stared out the bleary windshield. He couldn’t stay here, with nobody to see. He skated out onto the main road, heard a horn, traced the white line. Brake lights blossomed across the glass, rain pounded the roof like congas. He needed a pay phone. He pulled off the strip at some motel lights and opened the door, slid halfway out, stopped. The rain was cold needles on the back of his neck, soaking his knees. Who to call? Michelle wasn’t an appropriate choice at this point, and this clearly wasn’t a call he could make to Adrianne. The only other number he could remember was the babysitter. Then he sat on the curb and waited for the ride to the hospital.

  11

  April 1993

  The ambulance proceeded up the drive lined with leafless trees toward a fortress of ash-colored rock. The New Jersey State Lunatic Asylum at Morristown had changed little in its 150 years, except in name. These days, it was the Greystone Psychiatric Hospital at Morristown. Most folks called it simply “Greystone.”1 It was an impressive if intimidating facility of stepped domes and Empire colonnades, a classic of 1870s Kirkbride design as ornate as a tiered wedding cake. The name referred to the rocks themselves, gneiss slabs quarried directly from the seven-hundred-acre estate and stacked into a fortress sufficient to separate the townsfolk from the inmates. The day after tax day,2 1993, Charlie Cullen was transferred here for intensive inpatient treatment. He was taken through a plank oak door studded with iron spikes into a banal modern office to be processed.

  Greystone was a decrepit and outdated facility only a few years away from being permanently shuttered, with grooved linoleum halls and peeling paint. The asylum was understaffed and drafty, and the beds—which had once housed some seven thousand inmates—were now used by only a few hundred patients and supported by a skeleton staff. But the old stones still retained a manorlike majesty, and Charlie was flattered by the placement. The asylum had been constructed under the psychological philosophy that architecture was an essential component of mental hygiene, and Greystone’s bucolic view was as integral as the violent insulin shock therapy or the quieter psychosurgery in their approach to the rehabilitation of the depressed and suicidal.

  His room lay in one of the dormitory wings, which fanned from the main buildings like spokes from a wheel. Each room had a barred window framing calming pastoral views of hills and trees. A stately carriage road trailed gently into the wooded foothills of the real world. Such a setting, coupled with an abundance of light and exercise, might allow an inmate to unknot the tightest monkey’s fist of bad ideas, circular thinking, and other spasms of the mind that the increasingly industrialized world inflicted upon a fragile human psyche. The hope was that the disease of the mind arose from the environment, not the individual; change the environment and you change the man. At least, that was the idea.

  Certainly, during his stay Charlie felt less stressed. He was, in a manner, happy. Whether this constituted merely a temporary vacation from his old self, or some new discovery of his true nature, the question didn’t occur to him; happiness was a bubble that rough thoughts could prick. Greystone’s thick stone walls were like a basement built aboveground, providing insulation from the pressures of work and romance and an asylum from his triggers and compulsions.

  In therapy sessions, Charlie never had to fight to be recognized and validated. He learned to contain his known demons within pat psychological phrases. Talking about himself was encouraged; in fact, his personal issues were the only topics. He enjoyed his April. Each morning, Charlie would rise and look out over the asylum campus, taking in the rapidly greening lawn, the bare woods already hazing with the first buds. These were wet days filled with a cozy, gauzy weather, the light rain falling from a herringbone sky, the cardigan chill of the stone manse. There were no surprises, no triggers, no mail or calls. He felt calm. Maybe because of the attentions, maybe the meetings, maybe the meds—but April was good. And then the calendar turned a page, and vacation was over.

  The skies brightened, the clouds burned off, and the heat arrived early. Each day set a new record, as if God was just cranking up the volume. The second week of May hit ninety degrees. The dormitory became an oven, the windows were hot squares, wince-inducing. Weather was the first topic at the group meetings now, weather actually worth talking about. But the focus had splintered. It was another stunningly hot day when Charlie saw the note waiting in his cubby hole.

  Patients didn’t have telephones at Greystone; all calls came in through the antiquated switchboard, with messages relayed by pencil on small white pieces of paper. Charlie recognized the familiar 908 area code and the Warren Hospital switchboard exchange, and he knew, Okay, this is it. He’d actually wondered if they’d bother with the formality of firing him, or whether this was something more serious.

  He hadn’t exactly presented his best face at Warren Hospital. Charlie wasn’t particularly concerned about blowback from patient deaths. Only two came immediately to mind, and those had been quiet and largely unremarkable. But Charlie’s own emotional breakdown had been anything but subtle; his private business had been entirely public there. The staff knew all the juicy details of his stalking episode, they’d seen him wheeled into the ER by the babysitter. Charlie knew what that looked like: Michelle’s stalker, fresh from another failed suicide attempt, halfway between jail and the nuthouse. At least they were paying attention. He’d return that call.

  When he cradled the phone five minutes later, Charlie wanted to laugh—not out loud, of course; laughing to oneself was discouraged in a psychiatric facility—but it was funny. The call had been from Warren Hospital, all right. They wanted to know when he was available. As long as a Greystone physician cleared him for work, Charlie was headed back to the night shift.

  12

  The basement apartment had been shuttered while Charlie was away. Now he reclaimed his space, applying the Kirkbride style to his own private asylum. The lot directly adjacent to his building was empty; Charlie put his between-shift energies into converting the weedy plot into a garden. He soaked up sunshine while his store-bought seeds did the same. The flowers needed him. Here between his hedgerows, Charlie was in charge.

  At Warren, he’d sometimes catch a glimpse of Michelle Tomlinson between the closing doors of the elevator, or a flash of her hair glossed by the yellow lights of the parking lot as she walked to her car, and each time he had to strangle the impulse to call out to her. But Michelle either never saw him, or pretended not to. It didn’t matter, because even if she had seen him, the restraining order prevented them from working together on the ICU—a point needlessly explained by Charlie’s new nursing supervisor, Connie Trembler. Charlie didn’t need someone telling him what he could and couldn’t do. He was determined to be good. Connie had gone on and on about the new rules but Charlie had kept his expression blank. He knew he’d messed up with Michelle. Silence was the best penance he could offer. And anyway, Connie had moved Charlie to a great posting next door, in Telemetry, w
hich had its own secret rewards.

  Telemetry was a halfway ward, a sort of purgatory between the eyes-on intensity of Intensive Care and the hotel-like existence of a regular hospital inpatient. The ward was primarily reserved for heart patients—not the critical ones but those on the mend, whose stability might suddenly nosedive. Such patients needed to be carefully watched.

  Of course, from a patient’s perspective, purgatory was extremely annoying. They were strung with wires and IVs like marionettes, tethered to a beeping, flashing, and sometimes sighing machine, like the beeping thing in soap operas, the one that flatlines in the dramatic parts. As telemetry patients were not heavily sedated, the association made them nervous, which did nothing positive for their blood pressure, and sent the machine beeping double, which was where Charlie came in. His main skill was Patient Education, a one-on-one scripted pedagogy he enjoyed. Charlie was encyclopedic in his iteration of the technical details, and he had effective means to explain the devices. He explained that, Yes, fearful patient: you are hooked to a lie detector test, at least aspects of one.1 But when you understood how it worked, a polygraph wasn’t really all that frightening. And Charlie certainly knew; at this point, he understood better than most cops how they worked.

  The electrocardiogram (EKG) contains an incredible amount of information. Blood comes in the top of the heart and flows out the bottom, pushed by the squeezing of the chambers, atria to ventricle. The squeeze is triggered by an electric impulse. The EKG translates those electrical pulses into a picture, drawn by an inked needle jerking across rolling graph paper.

  Usually, Charlie explained all this as he applied the electrodes to the taut rib cages of the elderly, the dry eraser nipples, the merkin of hair.

  In the healthy heart, the muscle rippled, moving blood through the heart like a farmer’s hand moves milk through a cow’s teat. On the EKG, the stages of a normal pulse looked something like a mountain range. The information lay in the size and spacing of the peaks. Some looked slurry or slouched or notched, others read as irregular as an earthquake. Looking at the paper, a nurse could tell which; beneath the johnny, behind the ribs, the heart was trembling like a bag full of mice.

  Charlie’s pending divorce had led to two polygraphs that spring. The first was precipitated by Adrianne’s allegations that her husband was a dangerous alcoholic who drank while watching the children. This, and a restraining order, requested in the wake of her domestic-violence call to the police, formed the core arguments in her request for full custody of their children. The polygraph was Charlie’s idea. Arrangements were made on June 18, two months after Charlie was released from Greystone. According to the machine, Charlie passed the test; he was telling the truth. But this was only a small victory within the bizarre war he had been waging in the courtroom, and twelve days later Adrianne was granted a final restraining order against her husband.

  If the divorce proceedings in the Warren County family court system were not going well for Charlie, neither was his case in the Northampton County Court of Common Pleas. Charlie had been charged with stalking, breaking and entering, and trespass and harassment. This was a criminal situation, far more complicated than his divorce, and pursued by an aggressive and intimidating government prosecutor. Charlie had initially decided to represent himself but quickly realized that he was in over his head.

  Charlie needed to demonstrate financial need in order to qualify for a public defender. But while his application listed his necessary outside expenses, such as $1,460 a month in child support, psychological counseling fees, and credit card minimums, he neglected to list his most basic personal, day-to-day living expenses such as rent and food. It wasn’t a chance oversight—the droll expenses of his physical sustenance simply were not the needs that mattered. Charlie did not list them, because they did not exist for him. He was flat broke, but his net income appeared too healthy for the court, and his application for public counsel was denied. Now Charlie needed to pay for a defense lawyer, too, putting him further into debt.2 He picked one from the yellow pages and paid the retainer. The relationship lasted three days before the lawyer quit, claiming that Charles Cullen was “too difficult” a personality to represent as a client. With no outlet to vent his frustrations in the courtroom, Charlie directed his rage against his former lawyer instead. He wrote long, ranting letters to the court, comparing the legal profession to his own. Would a nurse simply walk out on a patient? he asked. No, he would not. Why not? It was unethical, and therefore unprofessional. The venting didn’t improve his situation. Now he had no choice but to represent himself.

  Charlie was nearly incoherent in court, and he knew it. On August 10, he gave up and simply pleaded guilty to the lesser charge of harassment and defiant trespass. He was given a fine and probation but no jail time. He was free to go home, where he tried suicide again, this time with pills and wine, driving himself to Warren Hospital and admitting himself to the emergency room. The familiar combination of his own willful actions and his resulting helplessness relieved some of the stress, like a sneeze or a compulsion acted upon, but the relief was short-lived, and the next evening Charlie was released to drive back home in the fog.

  The basement apartment was oddly cool, even in August. The only sound was the soft tchuckk, tchuckk, tchuckk of the stove clock, counting the seconds. Michelle had a phone, and he knew where she lived, but using either was a violation of his probation. He had been squashed and silenced, but still needed to speak. He was clicking in time with the clock again, teeth edges together, tchuckk. tchuckk. Winking one eye then the other, watching the wine bottles in their parallax dance, left, right, his elbows hard on the kitchen Formica as he put the words down on paper for the judge.

  “Their was a sexual intamate [sic] relationship between Michelle Tomlinson and myself,”3 he wrote. This judge didn’t see him, not as Charlie wanted to be seen. But Charlie had seen judges. They had been his patients in the Saint Barnabas Burn Center—fragile men stripped of their robes, reduced to probabilities, breathing by the grace of a machine. He wrote until the sky was inky with morning. He brushed his teeth, spitting red into the sink, drove to hand-deliver a fat stack of handwritten motions. Then he went to see George, the court-appointed family services counselor who would determine Cullen’s future with his children.

  Charlie very much wanted to keep his kids, especially now. His young children were the unquestioning fans of a certain select version of himself. They were dependents, just like the patients under his care in the ICU. He believed that in time he might actually become the man that his children imagined him to be: A caring father. A good friend. A compassionate caregiver. Some people saw him that way. Some of his fellow nurses saw him that way. His mother had seen him this way. Adrianne had, once, and so had Michelle. Maybe, he thought, if he kept his kids, he could make them love him; they’d seen him this way, too. If Charlie was satisfied by their attentions, he might not be willing to risk losing them again. Maybe he’d have no reason to keep dosing patients at the hospital, such as Ms. Natoli. Charlie would be the good father and the good nurse, an outcome he believed George and the family court should want. George’s recommendations held the key to this potential future, and so Charlie was always sober for their mandatory interviews.

  Of course, George had no idea that Charlie was killing people. But he was very much aware that Charlie was regularly attempting to kill himself, or at least making grand gestures at it. George noted in Cullen’s file that suicide was “the most severe and ultimate form of abuse/neglect, rejection, and abandonment one could inflict on one’s children.” Later that week Adrianne’s lawyer used the report in family court. Combined with a host of other evidence regarding Charlie’s drinking, the police calls, and Adrianne’s concerns that if Charlie was left alone with their daughters, he would “impulsively take his life and theirs.” Charlie had no standing in the courtroom. The only arena in which he still had gravitas was in the hospital.

  13

  September 1, 1993
<
br />   He didn’t know what he’d do, exactly, it wasn’t a decision, but he had been visiting the ICU lately, and he was zeroing in. A Mrs. Helen Dean was scheduled to leave the hospital the next day. She was an elderly woman recovering well from breast cancer surgery, and she had an adult son, Larry, who seemed never to leave her bedside. Something about that detail forced Charlie’s decision.

  The digoxin was in small glass ampules in the hospital drug closet, loaded into a plastic drawer called a cassette. Digoxin is a common drug on the ICU, called “didge” by the nurses, and written quickly on charts as “dig.” A pharmacopeial relative of the Foxglove extract digitalis, dig was used in the hospital to slow the firing mechanism of the heart muscles. Charlie loaded three amps, thinking, Three times point-five mills, that’s a milligram and a half; intermuscular, it could be enough. He palmed the syringe as if he were doing a magic trick, and walked into the room.

  The way Larry Dean remembered it,1 he was sitting at his mother’s bedside when the male nurse entered. Immediately, something struck him as odd. Larry had been at the hospital every day since his mother had come in. He knew all the nurses, at least by sight, and would especially remember a male nurse. He’d never seen this guy. That was strange, but stranger still was that this nurse was dressed entirely in white, like an ice cream man. Every other nurse he’d seen at Warren was dressed in blue.

  The nurse in all white told Larry, “You’ve got to leave the room.” The nurse said this without eye contact or facial expression. So Larry did what he was told and headed down the hall for a coffee. He returned ten minutes later to find his mother, alone and angry. “He stuck me,” she said.

  Helen Dean pulled up her johnny and pointed to a spot on her inner thigh. Larry had his Swiss Army knife, the deluxe kind with the little magnifying lens, and sure enough, there was a pinprick. So Larry called the doctor.