Award-Winning International Journalist & Author of the Bestselling True Crime Book, "The Good Nurse"
Charles Graeber is an award winning journalist and author of The Breakthrough, Immunotherapy and the Race to Cure Cancer. His previous book, The Good Nurse, was a New York Times bestseller and Edgar Award finalist. His writing has been anthologized in collections including The Best American Science Writing, The Best American Crime Reporting, The Best American Business Writing, The Best of 10 Years of National Geographic Adventure, The Best of 20 years of WIRED, and The Best American Magazine Writing selected by ASME and The Columbia Journalism School. He is an American Poets Prize and National Magazine Award finalist, an Alfred P. Sloan fellow, and recipient of the Overseas Press Club Award for outstanding international journalism. He currently serves on the board of The Writers Room in New York and Building Markets, an international nonprofit that works to empower refugees from war, poverty and persecution. Born in Iowa, he is now based closer to water.
Almost every nurse educator has used a piece of literature in some way, shape, or form to provide students a vicarious, visceral, and unforgettable learning experience. In this issue of Teaching and Learning in Nursing (TELN), author J. Scott treats readers to a review of Five Days at Memorial, an unflinching account of care provided to clients in the wake of hurricane Katrina. This work clearly meets criteria for providing students a vicarious, visceral, and unforgettable learning experience. This is a must read for every nurse and every student nurse.
“The Best Journalism of the Year”
- Charles Graeber, The Good Nurse When Charlie Cullen worked a shift, patients died. Lots of them, over the years. The reclusive nurse, it turned out, may have administered lethal injections to as many as 400 people, which would make him the most prolific serial killer in American history. Graeber's account — seamlessly crafted from interviews with co-workers, families of the victims, the detectives straight out of a pulp novel who cracked the case, and even Cullen himself — goes way beyond standard serial-killer fare: It's a scathing indictment of a greedy medical system that, wary of possible lawsuits, didn't want to deal with a ''problem'' employee like Cullen and just kept kicking him from one hospital to the next. —Tina Jordan Published by EW Staff
Mr. Graeber has compiled the full Cullen story into “The Good Nurse,” a stunning book with a flat, uninflected title that should and does bring to mind “In Cold Blood.” Mr. Graeber was well aware that to immortalize this nurse’s chilling deeds was to exploit them; promoting the book may have the same effect.
Both he and Mr. Cullen know that the story appeals to prurient interests, as does any graphic tale of true crime. But “The Good Nurse” succeeds in being about much more than Mr. Cullen’s murderous kinks. The causes of his pathology are not interesting. But the eagerness of ambitious hospital administrators to cover up his misdeeds is revelatory. And the police investigation that brought him down is a thriller in every sense of that word.
He was supposed to be an angel of mercy — but he was an angel of death, and likely the most prolific serial killer America has ever seen.
Charles Cullen had most recently been a nurse at Somerset Medical Center in New Jersey when he was arrested for killing patients with drug cocktails he secretly administered. He confessed to 40 murders in New Jersey and Pennsylvania — though investigators believe he may have killed as many as 400. He is currently serving 17 life sentences.
It was never revealed how detectives were able to stop him — until now. In a new book, “The Good Nurse,” author Charles Graeber unveils the identity of a confidential informant, Amy Loughren, who cracked the case.
Loughren was another nurse at Somerset, a co-worker and confidant of Cullen. Contacted by detectives, Loughren agreed to provide them files from the hospital, wear a wire to try to get him to confess, even talk to him in the interrogation room.
It was Loughren who first realized the scope of Cullen’s madness. This exclusive excerpt reveals the chilling moment, in November 2003, that Amy Loughren discovered how Cullen was picking — and killing — his victims.
Amy found curious combinations of drugs that Charlie had consistently ordered. The list was long, sometimes half a dozen in a night. Amy knew these drugs to be more commonly used in a cardiac unit. Charlie was working in intensive care. His orders emptied the supply drawers.
Then, time and time again, Charlie ordered a restock from the pharmacy. His position meant he’d be the first to take the delivery. At the time, he was seen as being helpful. Now Amy wasn’t so sure.
The two Somerset detectives who had contacted her, Tim Braun and Danny Baldwin, were investigating the deaths of a handful of patients who had suspicious levels of a heart drug called digoxin in their systems.
HOW HERO NURSE GOT CHARLES CULLEN TO CONFESS
Detectives were trying to trace a single gun; Amy thought this was pointing to an entire arsenal.
Charlie had been bartending, titrating a pharmacopoeial mélange, from both drugs he’d pulled from the cabinet and drugs he hadn’t.
Each drug in the cocktail had a specific biochemical effect. Together, they were a biochemical symphony. In combination, it didn’t require nearly so much of any one drug to push a vulnerable patient over the edge. One drug pushed while the other pulled.
Only the patient’s reaction mattered. The gap of time between the serving of the cocktail and the patient’s reaction was suspenseful. There might be a crash or a code or a Lazarus-like recovery. The cocktail was the riddle and the lab reports were the answer.
Amy had imagination enough to make sense of the patterns, but she couldn’t begin to imagine the monster that amused itself with them. All she was certain of was that it wasn’t the same gentle soul who was her friend Charlie. The emotional disconnect bothered her as much as the murders themselves.
Amy considered herself to be a perceptive person — a spiritual traveler, a listener with well-tuned antennae for the frequency of vibes. Growing up as she did, she had always assumed that if she was near a monster, she would feel it. And yet, standing next to Charlie, she had never felt anything like evil.
Maybe she’d gotten him wrong, or maybe her antennae were broken. Or maybe, Amy thought, she was half blind and could see only the good in people.
Somerset used a computer system for keeping track of patients called Cerner. Charlie’s Cerner pages told her she had assumed wrong. Charlie was not, actually, the world’s greatest nurse, the world’s greatest chart keeper Amy had ever seen. He had hardly typed a line.
It was, in fact, the worst charting Amy had ever seen. There were blotches of words here and there, blurts, spasms of hurried and misspelled observations. It couldn’t have taken him more than a minute to do that work. Whatever he was doing on the computer, it wasn’t input. That meant Charlie had been outputting something.
Amy had to wait until her next shift to print out the rest of the records. This time, she couldn’t wait until she got home. That morning she called ahead, then brought her paperwork to the second floor of the prosecutor’s office to share her discovery with the detectives.
The Cerner automatically kept track of everything a nurse did within the system and provided a time and date stamp of every page a nurse had browsed. Charlie was browsing all night. That was what he was doing. Browsing.
Cullen’s computer records were the most incriminating piece of evidence the Somerset County Prosecutor’s Office had against him thus far. But in order for the detectives to understand it, Amy needed to provide a quick primer.
Cerner had been introduced to the medical profession only a few years before as a compact and efficient way to input notes on patients, to look up their allergies, code status, lab values, etc.
But nurses were only supposed to do that for the patients they were caring for on shift.
What nurses never did, at least not any nurses Amy had ever known, was use Cerner to look up the status of other nurses’ patients. But that, it seemed, was exactly what Charlie Cullen had been doing.
Amy started with Charlie’s June forays into the chart of one patient, the Rev. Florian Gall. The hospital records showed that Gall had gone into cardiac arrest at 9:32 a.m. on the morning of June 28 and died approximately 45 minutes later.
Gall was not Cullen’s assigned patient on the night he died. Yet the Cerner records showed Charles Cullen snooping into Gall’s medical chart at 6:28 a.m., then again at 6:29 a.m. on June 28. He was checking in, only minutes apart, looking for something only a half-hour after a digoxin spike had registered in Gall’s lab work and three hours before the digoxin levels in Gall’s system would stop his heart.
“And that’s just Gall,” Amy said. The Cerner records contained lines and lines of Charlie Cullen’s log-ins at the computer, thousands of them, sometimes hundreds a night.
“He was studying them,” Danny said. “Why the f— was he studying them?”
Amy thought she knew. The nurses had IV bags lined up for them. But what if Charlie had made a drug cocktail, and injected it into one or more of the IV bags sitting by where he worked?
He wouldn’t need to bring them to the patient’s rooms, he wouldn’t need to be present at all. The other nurses — even Amy — would do that work for him. Charlie could simply retreat to his corner and use the Cerner to scan the lab reports and the patient’s progress.
Cerner would tell him where his loaded IVs landed. He wouldn’t need to be present for the death to feel the impact; you could just scan back on the Cerner anytime and follow the action.
It could be that same night or the next day, it didn’t matter; the event was always available on the screen to be relived again and again.
Was that what he was doing? Amy felt her heart beginning to sicken. She had delivered his drug cocktails.
And her friend Charlie had been following the action across the ward, like the box scores on a sports page.
Excerpted from “The Good Nurse: A True Story of Medicine, Madness, and Murder” (Twelve), by Charles Graeber, out tomorrow.
Cover Story After the Tsunami: Nothing to Do but Start Again By Charles Graeber
Kenji Sano was two years old the first time his home was destroyed. His family had a small wood and rice paper house in Kamaishi, right on the town's main street, parallel to the port and near the ancient blast furnaces that produced iron used in everything from samurai swords to rails for high-speed bullet trains. Sano hid amid the tombstones on the Buddhist hillside, clutching his mother as the tsunami of Mar. 3, 1933, swept his town away. Later, on the spot where his mother helped burn the bodies recovered from the wreckage, the survivors placed two steel Bodhisattvas, commemorating the high-water mark. Little Kenji-san sat before the arch of the temple gate, watching the smoke.
It was different the next time. Unlike the tsunami, which unpacked houses to timber, leaving things—everything—scattered, the American bombardment burned clean, leaving only ash. Three weeks after Sano's teenage home had been incinerated, on Aug. 8, 1945, the bombardment started again. An atomic bomb fell on the southern city of Nagasaki the next day. There would be no bombs after that. Kenji helped his father and brother rebuild. Theirs was a small place, no more than a barrack, but enough. There was nothing to do but start again.
BEST FACT CRIME The Good Nurse: A True Story of Medicine, Madness and Murder by Charles Graeber (Grand Central Publishing – Twelve)
"A thrilling and suspenseful page-turner that is sure to be loved by the majority of readers, who will be both horrified and fascinated."
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