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

by Charles Graeber

  Mary picked up the phone.

  Danny typed up the incident in the black-and-white of police-report-ese:

  This detective responded to the Somerset Medical Center and met with Director Mary Lund, to discuss the necessity of obtaining Cullen’s PYXIS activity in its entirety…. During this meeting we also discussed various alternatives that may allow us to obtain this information.

  Note: throughout the course of this investigation detectives were informed that the PYXIS system only stored data for (30) thirty days.

  At the conclusion of this meeting, Ms. Lund made several telephone calls inquiring about possible ways of retrieving this data.

  As a result, the requested information was subsequently obtained and turned over to this detective along with work assignment sheets for every patient in the Critical Care Units during Cullen’s tenure at this Facility.

  The Pyxis reports printed out like a spreadsheet. Danny saw each of Cullen’s trips to the drug computer as a time-stamped line of information, showing the units and type of drug ordered, and the patient to whom it was billed.

  But the orders on the evening before Reverend Gall’s overdose the Pyxis indicated that Cullen had not withdrawn any digoxin during his shift, and that evening looked very much like the evenings before and after. This was supposed to be the jackpot. But if there was a smoking gun there, Danny couldn’t see it.

  44

  On November 4, 2003, the detectives started scheduling interviews with the Somerset Medical CCU nurses, hoping to find a source of information unfiltered by corporate lawyers. The Somerset Medical Center administration lawyers requested that all interviews be conducted within the hospital, in the presence of Risk Manager Mary Lund. The assistant prosecutor had agreed to the conditions. Both Danny and Tim were furious, Tim going so far as to tell the AP, the prosecutor, and the police chief, too, that the whole interview process was now officially a “crock of shit.” In private, the chief, the detective captain, and the other detectives agreed with Tim1—but they didn’t say it in the meeting, in front of their boss—which, of course, was exactly his point.

  Orchestrating that waste of time was Danny’s problem. Danny delegated detectives Russell Colucci and Edward Percell to conduct the interviews.

  The daily reports provided an encyclopedia of information about nursing procedures and scheduling and physical layout—all essential groundwork, none of it game changing. Not all of the nurses had worked with Charles Cullen. Those that did used many of the same words to describe him—“quiet,” a “loner,” a little “bizarre” in his personal behavior, but professionally “excellent.” Most showed at least a mild affection for their quiet, quirky coworker, and they were particularly appreciative of his willingness to pick up shifts.2 Reviewing the interviews later, Tim and Danny couldn’t help but come to the conclusion that aside from the murders, Charles Cullen might have been a pretty good nurse.

  But what the interviews didn’t reveal was anything of the slightest use to a homicide investigation. The descriptions they gave were brief and sterile. Danny couldn’t be sure if the nurses didn’t know anything, or if they were just being quiet in front of Mary Lund. Each time his detectives asked a question, it seemed like the nurse would reflexively glance over at Lund before speaking. Finally toward the end of November, Danny decided to change tactics. From now on, he’d be doing the interviews himself, and alone. So far, all the detectives had done was ask the nurses to provide information, with an administrator sitting right there. The detectives had been told not to share any of their suspicions with the Somerset Medical Center staff. The nurses were confused by the process, and had little incentive to open up. They didn’t even know exactly what the investigation was about. For all they knew, they were the ones in trouble with the law.

  Colucci and Percell had been told to run it that way—Tim and Danny couldn’t risk a leak to Cullen or the newspapers, or even to the Somerset Medical administration. But Danny knew that if they were going to get anywhere, he would have to bend the rules, and take the leap of trusting somebody. Colucci and Percell weren’t in the position to make that call, but Danny was. And so, only three days after storming into Mary Lund’s office to demand the Pyxis information, Danny and Mary were spending five to ten hours a day crammed together in a little room off the Somerset Medical ICU,3 both of them hating every minute of it.

  By necessity, the two had reestablished a friendly, if false, work rapport. But Danny noticed that something fundamental had changed in Mary Lund. It was as if the woman was suffering a slow-motion nervous breakdown. Lund was getting it from both sides, the bottleneck between the hospital and the murder investigation. She was the risk manager in a situation of unprecedented consequence in lives and jobs and dollars.

  Mary had been losing weight steadily since the investigation started, and it didn’t seem to Danny like the intentional kind—Danny had known women, when they lost a pound or two, to go out and buy something new to show it off. Mary Lund had lost maybe twenty pounds but she was trying to hide it, shrinking inside her pantsuit, nervous as a hare. The presence of Danny Baldwin in the room wasn’t helping her nerves, either.

  Amy had been telling her girlfriends for weeks that she was definitely not down with the whole investigation thing.

  Waves of paranoia swept the unit. Each secretly feared the police interviews had something to do with her personally, and that it could affect her future. The nurses whispered together in the hallways, forming alliances, choosing sides. Each shift amplified and distorted the rumors from the shift before. Most of the rumors were about Charlie. Two weeks into it, the rumors were about Amy, too.

  Everyone knew she was “Charlie’s friend.” They remembered the stink Amy had made about signing for insulin. Apparently, there was a death involved, and both insulin and Charlie were mixed up in it. Some of the nurses now avoided Amy, as if suspicion was contagious. Her friends were worried for her. To tell the truth, Amy was scared for herself.

  She always played the tough girl, but inside, she was terrified—freaking out-of-her-mind scared. What had she done? Amy’s heart condition required that she take daily antianxiety medication. Had she taken too much Atavan one night and made a mistake? Were there narcotics missing, was the insulin issue to blame? It could be anything. Amy called to ensure her RN license hadn’t expired, and it hadn’t. So what was it, then? Amy wondered whether she needed a lawyer. Every time the detectives made an appointment Amy would call in sick. After two weeks she could avoid it no longer. Her manager sent her to the room.

  Inside, she found Mary Lund and a police detective, a big black guy in a suit and tie. He asked her to have a seat. He called her “Ms. Loughren.” There was a water pitcher and Dixie cups. Amy felt like a criminal. Her heart was going to explode if she held it in, so she let it all out.

  45

  Danny had already been conducting interviews for a week,1 and right away, this nurse seemed different. She was clearly afraid for her job, just like the others, but the difference was, Amy came out and admitted it. And she didn’t glance over at Lund when she did.

  Amy Loughren had graduated from nursing school in 1988, making her maybe a few years older than Danny. She was a white woman with bleachy streaks of blonde hair, blue doe-eyes, and high, prominent cheekbones, tall and attractive, but not a fragile sort of beauty, more rugged and practical, and, despite her conspicuous curves, clearly comfortable with the guys. There was something easy about her personality that turned the formality of interview into a conversation with flow.

  She started right in, telling Danny that she had heard rumors that this investigation had something to do with her friend Charles Cullen, and both the rumors and the investigation “pissed her off, royally.” Clearly, this girl wasn’t holding anything back.

  Danny sat back in his chair, letting her vent, knowing right away, She’s the one.

  Amy didn’t remember finishing her shift or the long drive home. At some point she realized she was sitting in her dr
iveway, trying to make sense of her day as her breath turned to frost on the windshield. She’d been so defensive at first, so fierce. Protective of her Charlie. She’d told the detective exactly what she thought of his investigation, and she didn’t care that Mary Lund was there to hear it. But the detective hadn’t reacted as she’d expected. He listened, seemed calm, maybe even happy. That didn’t make sense, with him getting yelled at like that—Amy thought she even caught a smile. And then, rather than ask her questions, the detective started to give Amy answers. Things about what had been happening on the unit, information about Charlie. Some of it sounded familiar. A lot of it surprised her. Amy glanced over to see how Mary Lund was reacting, but Mary was gone.2 Amy had been so keyed up, she hadn’t even heard the woman leave.

  “Look, Ms, Loughren,” the detective said. “I don’t know why, but I trust you. Okay?” He slid a piece of paper across the table. Amy could see it was a Pyxis printout. It was Charlie’s, from the night Reverend Gall had died.

  By the time Mary Lund walked back into the room, the Pyxis page was off the desk, and the angry, defiant Amy was gone. In her place was a silent woman whose eyes held a glaze of tears and shock. Mary had looked across the table from the nurse to the detective, but Danny was no longer speaking, either. He was using every muscle in his face trying not to smile.

  Amy had seen Charlie’s Pyxis and knew it right away. It was obvious, at least to her. She had always fought to defend Charlie against the bullies of the world, the unfair accusations. The paper Danny showed her told her not to. For the first time, it was possible to imagine that Charlie had done something strange and terrible during those shifts. She could believe that now. But what she couldn’t do, what she still couldn’t imagine possible, was reconciling that paper with her idea of her friend.

  When she got home, Amy dumped her coat and her purse and fished the big bottle of Cabernet from on top of the fridge. She sat with a glass at the kitchen table. How was she supposed to deal with this? There wasn’t a self-help book for this one. She’d seen the drug orders. She knew what happened to Gall. Nurses didn’t do this. A nurse had done this. Her friend had done this. Maybe.

  Maybe it was selfish, but that was what hit her first. She trusted Charlie—or—had, like she’d trusted few others, and even fewer men. That was what her tough-girl persona was all about, armor against the world. After a lifetime spent wrestling with issues of trust, those struggles had come to define her. She made no secret of her torturous childhood. Her sexual abuser had practically been a member of her family. They trusted him. But Amy knew people, and what they were capable of. Growing up, a little girl hiding in closets and hampers and behind basement doors, she had prayed over and over to the universe, begging for the superpower of invisibility. Instead, he had found her, again and again. In the end, she decided, the only one she could really trust was herself. She actually carried her piggy bank to the local mental health clinic and asked the stunned secretary, “How many sessions will this buy me?”3

  It had taken years of therapy to stop the guilt. Her decision to survive, and then thrive, had been a conscious one. She didn’t want to be damaged, squeezed, and trapped in the wreckage of her childhood. She had decided she was too tough for that, and she acted the part. She had decided, with the therapist’s help, to engage in the world. And that was impossible without some capacity to trust her relationships with other people. That was part of her decision to go into Critical Care nursing. The patients there needed everything. Their dependency dwarfed her own, and she rewarded that trust with care. That’s what nursing was about: a good paycheck, yeah, but also a relationship which healed both parties. Or so she had thought. If the Pyxis was right, Amy had failed her side of the bargain. She hadn’t kept her patients safe. Now she didn’t feel safe, either.

  46

  Tim and Danny had started in the predawn darkness of November 24, still smelling of their shave and shower, the front seat of the Crown Vic outfitted with Styrofoam Dunkin’ Donuts to-gos and a clean stack of newspapers. They drove north out of Jersey, into the back roads and farms and vegetable stands of what Tim called “deep bumblefuck” New York, getting deeper with every turn into the mountains. The plan was to close the deal in person—away from the hospital, and before the girl changed her mind. At the time, they hadn’t realized that Amy was a long-distance commuter, hours away.

  Danny told Tim about the girl, a fourteen-year nurse, midthirties, kids, blonde and pretty and tough. She was known on the unit as a friend of Charlie’s, maybe his best friend. Giving Amy the details of the investigation had been a gamble, she might pass them on to her pal Charlie. Danny still wasn’t sure exactly why he took it. Partly it was his gut, telling him that there was something wrong with the pattern of canceled orders he’d seen on that Pyxis page, telling him to trust this girl when they could trust nobody else. Mary Lund leaving the room had given him a chance to test it.

  “Why’d Lund leave the room?”

  “No idea,” Danny said. “Maybe she needed to use the bathroom. Anyway, she’s gone, I slide this nurse the Pyxis printouts and she’s like—bam! Right away. It knocked her over.”

  “She say why?”

  “Yeah, well—first she was just like—stunned,” Danny said. “Then she’s just like, ‘Oh-My-God, Holy Fuck,’ like that, over and over. Sorta slowed down talking, like a witness, you know?”

  “Wow,” Tim said. “So she thinks Cullen’s dirty.”

  “I think she’s trying to figure it,” Danny said. “She kinda disappeared, I mean—it was like the information was too much, it blew her circuits.”

  “She say anything else about the Pyxis, what she saw?”

  “Mostly it was the ‘holy shit,’ ” Danny said. “She also said something, said, ‘Charlie and I, we wrapped a lotta bodies together.’ ”

  Danny explained how he thought maybe she was going to cry. He didn’t know when Lund was going to walk back in, and he didn’t want to tip her off, so they changed the subject.

  “This nurse had talked to Charlie after he was fired, called him. Somebody had seen his picture, he said, probably somebody from Saint Luke’s. Said they must have called Somerset.”

  “What picture are we talking about?”

  “Thing they sent out in the mail,” Danny said. He dug under the newspapers to his folder. “Check it out. Our guy on the hospital recruiting pamphlet.”

  Tim glanced from the road. It was a recruitment flyer, something the hospital gave to potential nursing employees, Charlie Cullen smiling like a school portrait. “You’re shitting me,” Tim said.

  “Look like a killer to you?” Danny said.

  “Yeah, well,” Tim said. “Who does?”

  The detectives arrived at the Loughren address a little after 10 a.m., finding a white Colonial in the woods, the girl standing cross-armed in the window. She watched the two men emerging stiffly from what she assumed was an unmarked police car, the black detective and now a white detective, both big guys with suits and mustaches like matching salt-and-pepper-shaker homicide cops, carrying a box of donuts and a tray of takeout coffee to her front door.

  Amy brought them into her living room. The men settled in, a little too big around the coffee table. Amy tucked her feet under her on the couch as Tim took the lead, laying out the Somerset Medical case, in detail now, and not using the official language to do it. Danny glanced at his partner; he’d given her some inside information to bait the hook, but the plan was to take it slow from there. Now Tim was just telling Amy everything. Tim gave Danny a shrug: what the hell. He’d started it. They had to trust somebody if they were going to make this case.

  The Pyxis sheet Danny had shown Amy at the hospital was only one of a stack. The detectives watched the girl picking through the pages, getting agitated. It wasn’t any one specific drug order, she said. It was all the orders combined.

  “First of all, if you printed out all my Pyxis orders, they’d be, like, a tenth of this,” Amy said. “Less, probably. Nobody
orders like this.”

  “So what does that tell you?”

  “Nothing specifically,” Amy said. “But it’s weird.” Charlie had been making a separate request for each drug he ordered. “It would be like ordering a dozen eggs, one egg at a time,” she said. And many of the entries were only seconds apart—even when Cullen had been ordering the same drug, for the same patient. Amy could think of no logical reason to do that.

  “How about the dig?” Danny said. “We’re interested in that.”

  Amy flipped through the stack from the beginning, starting with Charlie’s drug pulls from early in the year. “See that?” she said, running a fingernail down the columns. “And that, and that?”

  The detectives leaned in. “That’s the dig, yeah,” Danny said. He’d flagged that before. “Is it unusual?”

  “Uh, yeah,” Amy said. “Charlie was ordering dig like—I don’t know, ten times a month.”

  “Is that a lot?”

  “That’s maybe more than I’ve ordered the whole time I’ve worked at Somerset.”

  “Okay,” Tim said. “Wow.”

  “And this was in the ICU,” Amy said. “Dig is really not that common a drug there.”

  “Amy,” Danny said. “We want to ask something from you. We’re trusting you with this. Nobody else, none of the other nurses, know anything about this. The hospital doesn’t know this.”

  “We’re not currently sharing our information, um, freely with the hospital,” Tim said.

  “We don’t want them taking a defensive posture to the information, legally,” Danny said.

  “What Danny’s saying is, Somerset’s been covering their asses from day one,” Tim said. Danny glared at him. Tim ignored it.

  “They didn’t tell us we could get this Pyxis. They didn’t tell us about—well, let’s just say, we’re not totally sure we’re on the same side of this thing.”