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

by Charles Graeber

  “It could be a bug bite,” the doctor explained. But by the next day, Helen Dean was violently ill. She was sweating, exhausted. When her heart stopped, she could not be revived, and Larry could not be consoled.

  Larry Dean knew right away that something wasn’t right and took it upon himself to investigate. He complained to his mother’s oncologist, who confirmed that Mrs. Dean hadn’t been scheduled for any injection. He complained to his mother’s other nurses. They told him that the male nurse his mother had identified was Charles Cullen.

  Larry Dean’s next call was to the Warren County prosecutor. He said his mother had been murdered, and told them who had done it.2

  After injecting Helen Dean, Charlie had driven home and thought about his actions of the evening. He didn’t much dwell on it; he simply assumed that this time they’d figure it out. Wouldn’t they? Maybe it depended upon whether Mrs. Dean was dead. He went in to work the next day, and he was surprised it had taken twenty-four hours3 but, yep, she was dead. And yep, they were figuring it out. His work schedule was crowded with meetings about the incident. He was questioned by the doctor, the Warren administrators, his nurse supervisors, and two people from the Warren County Prosecutor’s Office, Major Crime Investigation Unit.4 Each wanted him to run them through the scenario aloud. Charlie denied everything, of course, including the injection. He watched as they searched his locker. Meanwhile, Helen Dean had been wheeled into cold storage, then thawed. A doctor from the Medical Examiner’s Office sampled the tiny injection site on her thigh. The medical examiner would test for nearly one hundred potentially lethal chemicals. But for some reason, they neglected to test for digoxin. Helen Dean’s death was determined to be of natural causes.5

  Meanwhile, Charlie’s supervisor informed him that he would be put on indefinite paid leave, effective immediately. That didn’t sound so bad, being paid not to work, until he sat home in his basement apartment, thinking, depressed, wondering if they’d come for him or if he should set it up so he could be a tragic suicide in jail, as he had after breaking into Michelle’s apartment. He had nothing to do and all day to do it, sitting on the couch until the TV numbed him, moving to the kitchen table, the bed, the couch again. The stove clock piled up the seconds: tchuckk tchuckk. The ambulance arrived just before 11 p.m. This time, Charlie left the door unlocked for them.

  14

  Charlie tumbled through the suicide cycle: emergency room to inpatient Psychological Hospital1 to outpatient counseling program. He popped out the other side to find the Warren County Prosecutor’s Office waiting. They did the usual interview. He denied everything. When the questioning ended, they brought in a polygraph.

  The wires connected his body to the machine. Inked needles scribbled the results on the graph paper, showing the spiking of the ORS complex and frequency of the P wave. Charlie knew that the spikes could be moved up or down, even stopped altogether. Changing those spikes was what he did for a living.

  The police didn’t know medicine and didn’t care about what the spikes and troughs really meant. They were interested in the most basic changes, pulse and rhythm. On the basis of this, they accessed what they called the truth. Charlie called it something else. Charlie knew these were changes you could control with digoxin, beta blockers, nitroprusside.

  The polygraph made gross assumptions. It ignored the most fascinating arenas of the EKG. It connected the truth in a man’s head and the action of his heart, running a string from one to the other like a child’s tin-can telephone. It was a stupid test, and Charlie passed it with flying colors. But personally, Charlie was pretty sure they knew the truth.2

  Charlie’s paid leave from Warren Hospital lasted him into the New Year, but he’d already decided not to go back. He would need another job if he was going to make his child support payments, especially at the high sum the judge had based on his eighty-hour-a-week work schedule. Charlie found it at Hunterdon Hospital, a pretty little nonprofit medical center in the boutique town of Flemington, New Jersey. The numbers of both Warren Hospital and Saint Barnabas Medical Center were provided as potential references.3 By April 1994, Charlie was making $23 an hour plus overtime in the Hunterdon Hospital ICU, and living up to his recommenders’ reviews.

  His October 1995 performance report from Nurse Supervisor Marjorie Whelan called him “a patient advocate… cares about his patient’s welfare… organized, very giving of his time, so much to offer, very bright, witty & intelligent.” He started dating Kathy, another nurse on the ward, unhappily married, apparently available, three kids. He was sated by her attentions, rather than those of the hospital, and that winter he received a photocopied certificate filled in with his name in magic marker from the Hunterdon ICU. “To Charles Cullen, in appreciation for ‘Grace Under Fire,’ ” it read. “For all the night shifts you helped out on, thanks!” Marjorie Whelan went further. “Charles is always positive and polite! An excellent patient advocate! Helpful!” she wrote. “He has no medication errors.”

  But in fact, he did.

  The change came as imperceptibly as twilight becomes night. It wasn’t a conscious choice—he couldn’t say exactly when or why—but as 1995 wore on, Charlie went dark. By November, the man who showed up to work each evening bore little resemblance to the dream nurse Hunterdon had imagined they had hired.

  He didn’t really remember the names of those he injected and killed,4 no more than he cared about the reprimands and write-ups now thickening his once-perfect personnel file.5 Some nurses complained that Cullen was “over-lubricating his patients,” turning them into “grease buckets” after he bathed them alone with the blinds drawn. The practice struck his coworkers as unprofessional, bordering on creepy, but his litany of medication errors was far more serious.6 Charlie was caught administering unprescribed drugs to some patients and withholding essential prescribed drugs from others. Nurse Supervisor Whelan couldn’t explain this sudden turn in her star employee or his new, bizarre behavior, but she grew concerned enough to pull Cullen’s patient charts. These weren’t normal mistakes. Whenever Nurse Cullen gave the wrong drug to a patient, he also failed to record that drug on the chart. The nurse was playing doctor as no doctor would. Nurse Cullen was even ordering his own lab tests. The requests were bizarrely specific, as if he was looking for something in particular.

  On the morning of July 19, ten days after Charlie had killed the elderly Jesse Eichin with a dose of digoxin, Whelan pulled Charlie into an empty room for a conference. She couldn’t make sense of the disturbing pattern she saw, so she presented an ultimatum. One more incident, Whelan said, and Charlie would be terminated.

  For the past two weeks, Charlie had been fueled by the hurt delivered by Kathy, who had gone back to her husband. Now, he turned all his attentions to this threat from his supervisor. One more? It was unfair. It wasn’t just Whelan, Charlie felt, it was all of them, the whole bunch. And so he’d told Whelan, said it right in that closed office: if they really thought he was that bad, he’d just quit. He’d quit right now, he said, if that would make them happy. Is that what they wanted? Charlie left in a hurried sulk, slamming himself into the car for an angry drive home. He pulled out the typewriter again, to make it official, and really gave the keys a workout, employing whole sentences of all caps and lines of solid “!!!!!” and “??????” for emphasis. It felt good to vent, to tell them that he had 170 hours of paid vacation time coming and he didn’t care, they could keep it. It felt good to say that: Keep it! One hundred seventy hours because of his perfect attendance. He told them to use the money to find somebody else. It was a grand gesture, a sort of suicide. Who but a righteous and wronged man, a good man of pure intent, would be willing to throw away paid hours? Especially one who needed the money as desperately as Charlie Cullen did? Charlie drove to a mailbox, intoxicated by the promise of its dramatic impact. He pulled back the metal handle, stuffed the letter into the chute, slammed it home, and opened it again to make certain it had really gone. Then he realized exactly what he’d done. He we
nt home to quickly draft another letter, hoping to catch the first, nullify it somehow—but it was too late.

  Whelan received Charlie’s resignation. It was gratefully accepted. He would be allowed to pick up odd shifts, but strictly as a freelancer, on a per diem basis. Charlie grudgingly accepted. His name went back up on the Hunterdon schedule. But Charlie never showed up. He sat in his rented basement room, listening as the phone rang and rang. He felt powerful again, ignoring them, holding his breath, really showing them, all of them: his ex-wife, his family, Michelle, Kathy, Whelan. Then his phone stopped ringing.

  God had turned off the spotlight. It was just him in his basement apartment, checking his empty mailbox. The final letter from Hunterdon arrived, wishing him “Good luck with his future career.” Charlie pulled out the electric typewriter again and grabbed one of the letters on the stack from his wife’s lawyers, copied the threatening official style of date and address, then dove directly into the unfairness of his situation:

  They had been interviewing others in house, I have been told before Loretta got back to me that when one of the interviewrs went up to LOretta and asked “Why are we even interviewing when no decision has been made about Charlie?”

  The respose was “THat’s not even a consideration, he too un-stable.”

  If Loretta who so freely told my co-worker that I was unstable, she should of also felt free to explaime if true why did they not insist that I be examed or at the very least not let this “UNSTABLE” co-worker continue to work, and tell this co-worker but we might offer him per diem.7

  Charlie didn’t see that he was in fact making an argument against himself, only that he was making an argument. The syllogism went something like this:

  A “dangerous” and “unstable” nurse should not be on the nursing schedule.

  The hospital administration put Charlie on the nursing schedule.

  Therefore: Charlie wasn’t dangerous; the complaints against him were unfair; Charlie was the only victim here.

  Of course, Hunterdon never wrote back. It cost him six weeks of unemployment and 170 hours of paid vacation, but the incident taught him a valuable lesson: Never put it in writing.

  15

  After his resignation from Hunterdon in October 1996, Charlie had simply driven straight up the road to apply at Morristown Memorial Hospital. Morristown HR rigorously vetted Cullen’s background through a professional service,1 but despite several discrepancies in his stated dates of employment, they hired him anyway. After all, nobody remembers their exact dates of hire and fire, not even an accomplished and accredited nurse with nine years’ experience at Hunterdon, Warren, and Saint Barnabas.2 Morristown needed staffers to fill the hours. In Charlie’s case that was seventy-five hours a week, plus whatever shifts he could grab, at a new rate of $23.27 an hour, working 7 p.m. to 7 a.m. on the Cardiac Care Unit. But Charlie was still reeling, and failed to give one of his better nursing performances at Morristown.

  The morning shift would arrive to find Charlie’s patients cowering in pools of their own blood, twenty-five washcloths in the sink, and junk all over the counter. They’d written it all up in the patient incident reports,3 which Charlie considered astonishing reading—he couldn’t believe how petty nurses could be, counting washcloths like that. One patient told Charlie’s supervisor that he “wanted to call the police,” but the police weren’t called, and Charlie got a lecture instead. They were watching him. He knew it, he’d seen it before. Morristown had it in for him. They’d noticed the pattern, especially with the drugs he was administering. He appeared careless, several times loading patients with the wrong dose of Diprivan4 or heparin. He was there for less than a year before Morristown fired Charlie, not for killing patients5—as he was certain he must have done, not many, just one or two, he couldn’t say—but for “poor performance” and what they called “nurse practice issues.” His superiors were concerned about their patients and their reputation. There were too many incidents to ignore.6 Even the patients were complaining.

  The final straw involved a male patient—Charlie didn’t catch the name. The patient had a surgery scheduled for the following morning, for which he had been prescribed regular doses of heparin. As his nurse, Charlie was supposed to administer the heparin; he didn’t, and the patient died. Naturally, the physician on call was furious, and Charlie got an earful, which he didn’t like. He told the doctor, and everyone else afterward, that it had been an accident. It was a weak excuse, but as far as he was concerned, he hadn’t been actively attempting to kill this man. More like, he wasn’t trying not to.

  Charlie’s mistake and the patient’s death were never explicitly linked, but the potential harm to the patient was gravely obvious. The administrative director, Lisa Gannon, called his actions “inexcusable.”7 Her concerns were validated by the chief of the Department of Cardiovascular Medicine, Dr. John Banas. Gannon wrote she was “concerned about Charles’ competence and ability to provide safe care.” He was moved to harmless busywork for the remainder of his shift, then sent home for a week. Charlie felt deeply wronged, but he didn’t confront them directly, not at first. He just drove home, flopped on the couch, and waited for the phone to ring. When it did, it was the administrative director’s secretary, calling to schedule a meeting. Charlie didn’t want to come in. He told the secretary, “If they want to fire me, they can call me on the phone,” and hung up. An hour later, Gannon called back. But now, it was Charlie who wasn’t picking up, figuring, Hey, now they call? He let it ring. Gannon kept calling, leaving messages on the machine. “Charles,” she said, “we need you to come in. We need to speak with you.” Yeah, Charlie thought. Now they need something. That was August 13. He was angry, and determined never to go in again. After several more messages, Gannon finally sent Cullen an edgy certified letter demanding his hospital ID and all other hospital property, “since your employment is terminated effective today.” That was August 14. A few days later, Charlie came in anyway, early for his usual Saturday night shift, and found his name crossed off the shift whiteboard.

  Without hospital work, he had no way to blow off his stress as he had before, taking it out on the hospital, showing them. Instead, he drove to the corner mart, loading up on Coke and chips and a thick pack of kid’s notebook paper. He spread out at the kitchen table and wrote a long letter to the Morristown director, Kathleen C. Chumer. He demanded to have his case reviewed. It felt good but it wasn’t enough, so he wrote again, typing this time, remembering that illegible handwriting was one of the reasons he’d been let go in the first place. His typing wasn’t particularly good, either, so Charlie corrected in ballpoint

  The responses from the director and the Hospital Review Board arrived a week later; each concluded Charles Cullen had been terminated appropriately. Charlie wrote again, demanding outside arbitration. Paperwork flowed back and forth for a month, certified mailings, faxes. The process was too slow to provide Charlie with any satisfaction, so he tried suicide instead, telling 911 he’d swallowed a handful of pills, and knowing the ambulance would be required to bring him to nearby Warren, where, at least, he was known.

  Usually, suicide cleared the air like a summer storm. The attempt was an assistance bell, always at the ready. When nobody else cared enough, the ambulance crews always did. The ER attendants always took him seriously. The little penlight in the pupils was a tiny spotlight not only on him, but right into him. The pressure cuff hugged his arm like a friend. Each assessment of his vital signs was a kindly and sincere nudge of his very existence. Charlie told the paramedics that he was an RN, as he always did, and made a point to call the things around him by their special names, johnnies, codes, stim-pack, so they’d know he was an insider. The ride to the hospital was a special time. But once he arrived, it was a different matter. Charlie Cullen was rolled into the ER as a familiar character at Warren Hospital, an eye roller, the former employee turned suicidal stalker freak. Did you hear? Charlie’s back. They wheeled him into a little area, drew the privacy cu
rtain halfway, watched him. Charlie knew how they whispered at the nurses’ station, the gossip that went on there, the rubbernecking at this accident dragged in off the human highway. He could almost empathize. But Charlie was stubborn when he had a goal. He wanted to go back to Greystone. It had been so pleasant there. Only a hospital could admit him. Warren had done it the last time he showed up in their emergency room—wouldn’t they just rubber-stamp him forward again? But the ER doctor required a blood sample first. What he was checking for, Charlie wasn’t sure—perhaps he suspected that Charlie hadn’t really been trying to kill himself, that he was simply gaming the system. The doctor would screen Charlie’s blood for drugs and make a recommendation of care based on what he found. He might not recommend Greystone.

  Charlie refused the blood test. He made it extremely clear to anyone who came into his curtained area. He had given blood plenty of times, dozens of times, hundreds of times, over twelve gallons of blood, by his own count, but this wasn’t him giving—it was them taking. Once decided, Charlie shut down. There would be no negotiating. Doctors and nurses approached, he pushed them away and started to leave, and when they tried to stop him he slapped them away again until finally someone at the desk called security. Charlie could only imagine what the nurses were saying about him now—And we even had to call security!—but at least he got his way.

  Ah, Greystone, ever so much grayer in October, as if the sprawling stone estate sucked color from the clouds themselves. Charlie arrived back at the haunted-looking mansion on the hill the day before Halloween. He’d have months. The familiar driveway was a salted seam of asphalt through bare poplars, and from his dormitory window Charlie watched snow muzzle the distant fields, followed tender plumes of wood smoke rising from invisible hearths. The outside world held its breath. There was nothing but time here, enough for a new drug routine to kick in, for the therapy sessions to get traction, time enough for a patient to clear his mind and refresh. But Charlie wasn’t interested in new thoughts, and when he was discharged on December 11, he drove straight to the police station to press charges against the Warren Hospital ER physician, the one who had tried to steal his blood. Charlie stood before the bewildered desk sergeant, making sure the man had it all written down before hopping back in the car to pick up his held mail. Most were bills for alimony and child support, and letters from the Morristown Memorial Hospital lawyers. After months of preparation, his review had been forfeited, because hadn’t paid his side of the arbitration fees.8 In January 1998 Charlie wrote back: he had been in a mental institution and had no employee handbook, so the delay was not his fault. He was a victim. In March he wrote again, threatened to sue Morristown Memorial Hospital unless they granted his extension.9 They sent Charlie yet another employee handbook, this time by certified mail, and granted his extension. But Charlie never wrote back. The matter at Morristown, once so desperately important, no longer seemed even to exist. He had already found a new outlet for his frustrations.