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

by Charles Graeber

  For a nurse, it was a stunning sight. The drugs are poison. They’re also money, and the job. Instinctually, the pair began to catalog their discovery on a legal pad. Among the finds were six bottles of vecuronium bromide, or “vec.” There was magnesium sulfate and phenylephrine, Levophed and dobutamine, nitroglycerine and labetalol, and forty boxes of the missing Pronestyl.

  Gerry and Candy had zero context for any of this. It didn’t fit any of their whispered scenarios, which revolved around drugs being stolen, for sale or use. This is a common hospital problem for drugs like ketamine, OxyContin, Vicodin, Percocet, Darvocet, Demerol, morphine—anything escapist and everything addictive. But who would want forty-eight boxes of phenylephrine? There was nothing vaguely recreational about depressed blood pressure or altered heart rhythm. They couldn’t figure it. The dumped bottles full of Pronestyl was one issue, weird and wasteful. It bothered them. The empty vec bottles were what scared them. Vec was what they called an unreconstituted drug. It came in a powder form, sealed inside a glass vial with a permanent rubber stopper. The only way to get the drug out of the bottle was to reconstitute it—like making Kool-Aid in a sealed container, using a syringe. This required loading a needled syringe with saline, stabbing the needle through the rubber stopper, injecting the saline, shaking vigorously, then withdrawing the reconstituted contents into the syringe. The empty vec bottles suggested that the drug had been withdrawn into a loaded needle, and in staggering quantities.

  Vec is an exceptionally powerful paralytic.3 Overdose by vecuronium bromide would be much like drowning or slow suffocation. The musculature of the body shuts down but the person inside remains intact, at least until the heart muscles and lungs fail. Worse, the patient would suffer all of it—vec would keep you from moving or screaming, but it would not stop you from feeling pain.

  Prolonged or excessive vec dosing had caused brain damage in comatose patients, and the possibility of hugely negative side effects made vec an increasingly unpopular drug amongst doctors. The rare prescriptions called for only small doses, usually around 5 mg.4 And none of the patients currently on the Saint Luke’s CCU had been prescribed vec during the entire four-shift weekend. Yet someone had apparently reconstituted 60 mgs of the dangerous paralytic into needled syringes and injected it… where?5

  Gerry Kimble stepped back into the hallway, suddenly uneasy. Patients lay unconscious in every room around him. The hospital itself was full of staffers, visitors, specialists, new hires, cleaning temps. He and Candy and Kim decided to keep an eye on the medical storage room, taking shifts between patients. Kim, going first, had a clear view from the nursing station. She didn’t recognize the first guy who stopped at the med room. She watched as the guy punched the code, worked the handle, and wedged a sneaker in the doorjamb to prevent it from closing as he restocked. She had him in direct sight the whole time. A half hour later she watched the pharmacy guy punch the code and enter. He too left the door open. Kim and Candy exchanged a look. It was getting silly. And they still had a day of patients before the shift change.

  At 6:20 p.m. Charlie Cullen walked into the unit, early as usual. Kim Wolfe was glad to see him—she liked Charlie. They’d been crossing shifts for over two years, not friends but friendly, saying hello and good-bye when their schedules happened to mesh. Sure, he was a little different, but Wolfe didn’t judge him for his quirks. He was helpful and generous with his time for anything another nurse needed. Kim and Candy kept their heads in their charts while Charlie made his ritual rearrangement around the nursing station.

  The chairs were these alien OfficeMax things with spider-leg wheels. Charlie wheeled the extras to a dead office down the hall, did two, then came back for another two. He took those, then stopped along the hall at the med room door. He punched the code and slipped inside. The door locked behind him. Kim ran over to tell Candy, but Candy was already watching.

  It was a full five minutes before Kim and Candy saw the door open. Both women looked down as Charlie stepped out of the room and walked the other way down the hall. Kim ran over to the med room door, punched the code, and peered inside. The sharps box was full again. The ICU floor manager, Ellen Amedeo, needed to be alerted immediately. They found her at home and breathlessly told her they knew who’d been using the deadly vials of vec.

  A half hour later, the day shift left, Gerry and Sue and Candy with it. Charlie stayed on. He had twelve hours. The first code came less than halfway through it.

  The sharps box wasn’t opened again until the shift change Monday morning, June 3. Day nurse Gerry Kimble and manager-supervisor Terry Koehler donned sterile gloves as a hospital security officer watched them upend the contents onto the counter. This time they discovered several dozen bottles, many of them empty, including ten spent vials of vec.6 Though they didn’t know it yet, the drugs had already had been used on patient Edward O’Toole seven hours earlier.7

  By now, Ellen Amedeo had arrived on the unit, and administrative wheels were turning. Janice Rader, Saint Luke’s Hospital’s risk manager, set a protocol: for the remainder of the day shift, the charge nurse was to regularly check the sharps box for additional stashed meds. Cullen wasn’t working; the sharps box remained empty.

  Rader had no choice but to contact Ken Vail, Saint Luke’s risk management director. Dangerous heart drugs were missing, massive quantities of a paralyzing agent had been activated and disappeared. Together, Rader and Vail strategized on what would be “best for the hospital,”8 given that nurse Charles Cullen was scheduled to be back on shift again in less than eight hours. The decision was to consult Saint Luke’s in-house counsel, attorney Sy Traub. Traub called in the Stevens and Johnson law firm,9 corporate specialists in criminal law and malpractice defense. One of their young Turks was a former Philadelphia assistant district attorney named Paul Laughlin.10

  By 2 p.m. Laughlin was sitting in the administrative offices at Saint Luke’s. He was briefed, then went home to wait. The call came just after midnight. It was the CCU nursing floor. Charles Cullen was back on shift, and another cache of drugs had been discovered in the sharps box. It couldn’t wait. Laughlin drove back to the ICU and parked himself in an empty room at the end of the hall. A few minutes later, a male nurse named Brad Hahn delivered Charles Cullen. Charlie hadn’t seen it coming. He cut Brad a look, telling him, “You know, you could have given me a heads-up.”11

  22

  The young lawyer asked Charles Cullen to take a seat. He started off friendly, asking Charlie about his background, his work habits.1 Charlie answered each question in order, pretty sure where this was headed. He told the lawyer he liked to get in early, about 6:30, and stock the drug totes. He’d done that today, it had taken about ten minutes.

  And after that? Laughlin asked.

  “Yes,” Charlie said. “I’d been, you know, in the med room after that.”

  And why, Laughlin wondered, would Charlie be in the med room again?

  “I don’t know,” Charlie said. “Maybe somebody asked me to. If someone had asked me, I would have gone in for that.”

  “Okay,” Laughlin said. “So—did that happen? Did anyone ask you to go in?”2

  Charlie looked at the ground. “I can’t remember,” he said. “I’m working on no sleep here, so, you know, I don’t really remember anything specific about the shift.” He was almost mumbling.

  “Did anyone talk to you about drugs being found in the sharps bin?”

  Laughlin brought the sharps bin over and opened the lid, showing it full of boxes and vials. Maybe Charlie was supposed to show surprise, but he didn’t. He didn’t care enough to remember what emotions people were supposed to have in these situations. What did it matter? He looked back to his spot on the floor. The linoleum was mottled like lunch meat.

  “So, let me ask you again: have you heard anything about medicines going missing?”

  This time Charlie said, “Yes. I’d, you know—Nurse Moyer, Thelma. She mentioned something about it.”

  So, Laughlin asked, who
put them there? Did he have any idea?

  The man kept talking. Charlie heard him listing all the shifts when the medicine had been found, the hours that corresponded to Charlie’s shifts. The man talked about the vec, demonstrating his understanding of how it was a dangerous drug that had to be reconstituted, mixed up, withdrawn by syringe. Who was on all those shifts but him? Anybody? Charlie? Charlie?

  Charlie glanced around the office, the desk, the chairs, the lawyer’s lap. He had the patient records, their blood work, the lab reports of the vec overdoses. They had the vials.3 To Charlie, this all added up to bullying. They knew already; the questions were simply cruel. “You’ve already made up your mind about it,” Charlie said. What did they expect him to do now?

  Charlie would be offered a choice4—well, it wasn’t really much of a choice.5 If he resigned, Saint Luke’s would give him neutral references, and the incident wouldn’t show up on his records. Charlie watched the floor. He was getting shuffled off, a dump. He figured this was how you keep a Top 100 standing in U.S. News and World Report. Charlie couldn’t believe it—a Catholic hospital, of all places. Saint Luke, patron saint of liability. He’d take the deal, but he knew he was the righteous man here. Security frogmarched him through the unit like Christ to Calvary and left him standing in the cool of the parking garage.

  23

  On June 8, three days after Cullen was escorted to his car by Saint Luke’s security, he was pulling into another lot just ten minutes down the road in Allentown, Pennsylvania, early for another night shift in another CCU. The transition to Sacred Heart Hospital was especially simple, as he’d been able to truthfully list his dates of employment at Saint Luke’s CCU as “June 2000 to present,” and count on Saint Luke’s1 for neutral references.2 His transition seemed normal. Charlie hadn’t realized that several of the administrators at Saint Luke’s had been calling around to their colleagues at other hospitals. And anyway, it didn’t matter—they hadn’t called Sacred Heart. Charlie was steered straight into his orientation on the ward. He would start right away.

  Cullen sensed he would like working at Sacred Heart. He already liked his coworkers, especially a young mom named Cathy Westerfer. Like him, Cathy was a new hire, single and working nights. He hadn’t been there a week before they were dating. As usual, Charlie attached himself quickly. Two weeks later Charlie got the familiar call, telling him not to bother coming back for shifts, but even that had an upside; Cathy felt sorry for her new boyfriend. The whirlwind arrival and departure seemed romantic, somehow. A few months later, Charlie would load up the Escort and move into Cathy’s rented house in Bethlehem.

  The blank on his Sacred Heart termination notice had read “interpersonal conflicts.” Charlie figured that basically meant some senior nurse had heard rumors about him. In fact, one of the Sacred Heart nurses had formerly worked at Easton Hospital, where the suspicious digoxin death of Ottomar Schramm still echoed. She’d heard the stories. Soon, her Sacred Heart coworkers heard them, too, and petitioned the administration. They threatened to quit en masse if Cullen wasn’t fired. Charlie didn’t know the details and didn’t need to. The bottom line was that he’d need to move further afield. A clean start was only as far away as the state line. Charlie was going home.

  Charlie still had the benefit of neutral references from Saint Luke’s. The hospital would later assert that Laughlin’s investigation, the chart reviews by Risk Manager Rader and Nursing Supervisor Koehler, and additional inquiries by Saint Luke’s general counsel Sy Traub all failed to identify any suspicious deaths related to the empty bottles of vec, or any other actions by Charles Cullen in their hospital. But Saint Luke’s administrators didn’t want Cullen working in their health-care system. And they apparently believed that other hospitals would have reason not to want him working in theirs, either

  In August 2002, Charles D. Saunders, Saint Luke’s senior vice president of medical and academic affairs, had called his colleagues in the local Bethlehem area, asking whether they had experienced any unusual incidents with a nurse named Charles Cullen, and telling them that Cullen was beyond consideration for rehire. CEO Vince Joseph3 and Attorney Paul Laughlin did the same.4 But Saunders, Joseph, and Laughlin apparently weren’t passing these warnings on to the public,5 the cops, or the State Nursing Board.6 And unfortunately for the patients of Somerset Medical Center, they weren’t on the call list, either.7

  24

  September 2002

  The recruitment flyer was a high-quality mass-marketing mailer, a full-color appeal for qualified nurses. Charlie studied the brochure over the kitchen sink, turning it over in his hand. “Join the Team!” it said. Should he? His life’s path had been shaped by doors that opened at just the right time, fate showing him the downhill path. Charlie didn’t know Somerset Medical Center, or Somerset County, New Jersey, but it was obvious that after five medical centers1 in less than four years, his name was burned in Pennsylvania.2 He’d had problems in New Jersey, too, but it had been four years since he’d worked there, and New Jersey was a big state.3 Although, Somerset County was only a fifty-minute drive from the house he’d been raised in, socially and economically, it was as far as Charles Cullen could hope to venture from his West Orange roots.

  Somerset was one of the oldest and richest counties in the United States,4 a fertile farming settlement set between wooded hills and the overgrand country estates favored by financiers and industrialists.5 John Dryden, a founder of Prudential Insurance, built his Versailles-like mansion in Bernardsville in the 1880s; a generation later, Brooke Kuser—soon to become Brooke Astor—would live in a manor called Denbrooke. In the boom years following the Civil War, these were the wealthiest citizens of the wealthiest nation on earth, and they could have anything they wanted. In 1898, what they wanted was a hospital.

  One death had done it, that of a sixteen-year-old boy with a blow to the head. Even in 1898, this was a far-from-fatal condition; drilling holes in the skull to relieve the pressure was a simple surgical procedure older than the Lenape arrowheads that still littered the Raritan River clay. But during the long wagon journey to Newark, the boy’s traumatized brain continued to swell like a baking loaf, crushing itself against the confining skull. By the time he reached Newark, the boy’s pupils had bloomed dead, and the cry for a local hospital was taken up.

  With an initial donation of $5,500, a house on East Main Street was outfitted with electricity and running water and the latest technology of modern medicine, including a German machine that could photograph the human interior by means of ‘unknown’ or ‘X’ rays, and a surgical theater sunned by a new electrical bulb recently invented by Thomas Edison of neighboring Menlo Park. It started with ten doctors to attend twelve beds. As the county grew, the hospital expanded in step, adding wings and annexes until the simple wood-framed town house had molted into a redbrick city catering to dozens of specialized medical procedures, with over 350 beds for overnight patients and thousands of highly paid professionals to attend to them. It was blessed with abundant parking and a convenient location between the highways, and prosperous enough to offer a $10,000 bonus to experienced nurses willing to sign on for a six-month hitch.

  On August 15, 2002, Charlie sat down at the desk of Somerset Human Resources and filled the familiar blanks.6 Nurse Cullen presented a tempting hire. He indicated truthfully that he was a certified and registered nurse, lied righteously about not having a criminal conviction, and wondered not at all whether they bothered researching those answers. He preferred Critical Care but would work in any ward, and was open to all hours, rotating shifts, on-call shifts, nights, weekends,7 and holidays. For references, Charlie listed Saint Luke’s, indicating that he had left only because he “needed change,” which was true enough. He also listed his years at the Lehigh Valley Hospital Burn Unit, which “did not work for him,” and Liberty Nursing and Rehabilitation Center, where “there weren’t enough hours available.” All were, in a fashion, true; it would be up to the Somerset Medical Center HR departmen
t to try and color in the details.

  Cullen’s former supervisor at Warren Hospital confirmed that Charlie had indeed worked there, and extolled Charlie’s work ethic, conscientiousness, and intelligence. And as promised, the Saint Luke’s HR gave his dates of employment and verified his former position.8 In September 2002, Charlie was offered a job working full-time with some of the most vulnerable patients on the Somerset Medical Center CCU.

  Charlie quickly became a popular night nurse at Somerset. Usually, the hand-off between the day and night shifts could last an hour, depending on the nurse, but Charlie was quick, he didn’t ask questions, and the day nurses were always thrilled to see him on the schedule. They could give him a quick report and go home, knowing he was already off down the hall with his little Cerner PowerChart, the mobile computer database of patient charts. His fellow night nurses appreciated Charlie even more; he started early, worked efficiently, and was always the first to finish. His colleagues would return from their initial patient checks to find Charlie already standing by the Pyxis machine, helping lay out their IV bags for the evening. Later, they would see him again, helping out at the code.

  Each night shift nurse had an independent schedule, and each night saw a different composite crew. Charlie was quickly singled out by one of the nurses he was often on with, a tall, pretty blonde named Amy Loughren.9 She was a self-proclaimed “pain in the ass,” which meant she was outspoken and honest, the kind of person who cast a shadow Charlie could shade himself by. Charlie was quiet around her at first, but over the long overnight shifts Charlie began slipping in wry comments about hospital bureaucracy while waiting for the Pyxis machine, or sending a dramatic eye roll across the room during a particularly labored evening report. Late at night, after all the drips had been hung and their respective patients tended, Charlie offered up slapstick tales of debilitating depression, bad luck, and bullied victimization with a wry honesty he believed Amy would connect to; she’d reply with laughter and the maternal attentions Charlie needed. As the weeks passed, they graduated from familiars to friends.