The Good Nurse: A True Story of Medicine, Madness, and Murder (11 page)

At Lehigh, burn nurses still scraped patients on a metal gurney, and they still used pressure suits, but burn wards were no longer the scream wards in which Charlie had come of age. The new drugs saw to that—the new “benzo” class of antianxieties that had accompanied a new understanding of the relationship between stress and pain. Morphine, the traditional therapeutic drug, seemed rather primitive next to the new classes of pain killers, especially OxyContin, which had entered the pharmacopoeial marketplace only three years earlier.
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Now there were drugs to effectively block the pain of even the youngest patients.

Along with the new drugs came new ways to track and distribute them, in the form of computerized cabinets called “Pyxis MedStations,” which were manufactured by an Ohio company called Cardinal Health. The Pyxis machine itself was essentially a great metal drug cash register with a computer screen and keyboard affixed to the top. Not all the nurses were comfortable with the new computerized element of nursing care, but Charlie actually enjoyed it. He’d always been good with the technical devices, and he appreciated how the machine efficiently tracked a nurse’s drug withdrawals the way a bank ATM machine traced cash withdrawals, linking each with
the account of a particular patient and nurse and creating a record. The Pyxis simplified billing and provided a means for the pharmacy to know exactly when any given drug was running low, and to send a runner for restock. It was a useful system, but hardly perfect. Ultimately, it was just another tool in the service of an intimate art, practiced by real people with flaws of their own.

C
harlie considered himself to be a veteran burn nurse, particularly in light of his time in the esteemed Saint Barnabas Medical Center’s Burn Center. But here at Lehigh Valley, Charlie felt like he was back in the Navy, treated like a freshman “new fish.” He didn’t like their attitude toward him or toward the patients. Their professionalism struck Charlie as heartless and unempathetic.
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He called them cruel and cold. They, in turn, called him a weirdo. And so, during the long overnights that winter, Charlie felt himself compelled to do what he had always done, not remembering the specifics of whether the patients he’d intervened with had come in from car accidents or house fires, not remembering how many he did
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over the sixteen months he worked the overnight. Most died during his shift, coding right there in front of those “cold” nurses. It was something he could do, an act of personal will in a tyrannical work situation.

On the burn ward, most of the young male patients were either drunken campfire burns or car accidents. A patient named Matthew Mattern was one of the latter. He had been trapped in the burning wreck, and rushed into Lehigh with burns over 70 percent of his body. His was a grim case, even for the most hardened nurses. The presence of such a young, critically injured patient on the ward brought a wave of fresh emotion and an uncharacteristic outpouring of distraught young visitors. The older nurses were reminded of sons or grandsons, the younger nurses of friends or lovers or even themselves. And while none of the staff had mentioned it, at least not in front of Charlie, many had privately done the math. By the rule of 9s, the twenty-two-year-old Mattern was 92 percent dead. He might make it, there was a chance of that, but eventual death was far more likely.

Mattern was what nurses called a “slow code”—a Code Blue in slow motion. Charlie had watched his progress, knowing that even if Mattern survived, if the transplants took, he would be forever damaged, an amputee bound in a cocoon of scar tissue and locked in a pressure suit.
Meanwhile, the surgeons were amputating him, piece by piece. Butchering him, the nurses thought. Mattern had been charred through to the bone; his extremities were gone.
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Eventually the surgeons would take everything. Many of the nurses prayed for the inevitable.

Charlie recognized the helpless feeling. He’d felt it when dealing with the veteran nurses, felt it the same way in the house he grew up in, from the strange and sometimes violent men who wandered the halls while his brother dealt nickel bags upstairs, from the boyfriends who continued to live in his sisters’ rooms even after his sisters had run away; and later, after Charlie had run away himself, he’d felt it again, in the submarine, when veteran sailors hazed the new fish for a tour until even newer sailors would come aboard and it was their turn. He’s been a quiet kid, solipsistic and friendless, and ill-equipped to decipher the social dynamics of Navy culture. He couldn’t take teasing, and soon it snowballed into more. The other sailors saw how he bristled too hard, how he’d drop his eyes and mutter under his breath then shoot a look, like he’d kill you in your sleep. They called him fucking psycho, fag psycho spaz. He was “fishbelly,” pale as death, except when snagged with the rat tail of a wet towel, when he went welt-red and batshit. Even his ears went red. Even the other new fish picked on him. Tour after tour, Charlie Fishbelly was always good for a laugh. But Charlie had left the Navy. He was in charge now. On August 31, 1999, Charlie loaded Mattern’s IV with a bolus dose of digoxin. The slow code was over before sunrise, some of the nurses thanking God for His intervening grace. Charlie merely headed back to the parking garage.

Stress-relieving impulses like these had driven most of his actions during the previous year. His intervention on behalf of his patients was a compulsion that had little to do with the patients themselves; often, in fact, he failed to notice the patients at all, only their outcomes. Each spasm of control offered a period of relief and afterglow. This lasted through the summer, and into the fall and winter, through the recurrent stress of the holidays. Finally, it ran out, and Charlie found himself just after sunrise, driving through a cold rain in the new millennium and pulling into the parking lot of his local Gas-N-Go minimart.

The hibachis had been stacked by the door by the wiper fluid and Styrofoam coolers. The one he bought was cheap and disposable, essentially an aluminum roasting pan with a grill top, but small enough to fit in the basement apartment’s clawfoot tub. Charlie squirted on the lighter fluid,
struck a match, and dropped it on the wet coals. He watched the fire flash and dance for a moment before remembering his glass, walked out of the bathroom to the kitchen counter, poured another drink, and carried it back to the bathtub.

The patrol car swung into the driveway of the Shafer Avenue apartment a few minutes later. An Officer Duddy spoke with the landlord, Karen Ziemba, who had placed the call to 911. She told Duddy about the smell and the ambulances Ziemba had sometimes seen carting away her troubled tenant. Duddy trudged back down the stairs to the outdoor entrance to Charlie’s basement apartment. The storm door was locked, and rolled towels had been stuffed into the jamb between the doors. Duddy banged hard, identifying himself as police. Soon the deadbolt clicked, and the door cracked open. Charlie looked out sheepishly.

“Sir,” Duddy said. “Are you having problems with the kerosene heater?”
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“Uh, no,” Charlie said. With the door open, the fuel smell was overpowering.

“Well, I’d like to check it for myself, if you don’t mind.”

“Well, um, it’s fine,” Charlie said, not moving.

“You might as well let me,” Duddy said. “Fire department’s on its way.”

Charlie sighed and opened the door. Duddy stepped in. The fuel smell was stronger now, and something was definitely burning. Towels and raw insulation had been crammed into the vents of the heating ducts. The smoke alarm lay on the kitchen table, stripped of batteries. Duddy looked back at Cullen. Charlie was looking at the floor. Duddy moved past Charlie, following the fuel smell toward the bathroom. The mini hibachi sat in the bathtub, burning. Charlie explained that he had placed it there, of all places, careful not to start a house fire—he was, after all, a nurse who worked in a burn unit. He had seen what fire could do. But Duddy radioed for an ambulance. Charlie sighed and went to look for his shoes.

When the ambulance arrived, Charlie asked the EMTs if they could take him somewhere other than Warren Hospital. He didn’t want to be seen as some kind of freak.
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18

April 2000

C
harlie was increasingly aware that his time at Lehigh Valley Hospital was running thin. The Burn Unit senior staff no longer disguised their contempt of Nurse Cullen.
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Charlie tried to transfer, but the Cardiac Unit wasn’t interested in inheriting the problem. Charlie continued at Lehigh for three months, ameliorating the hurt by killing patients
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and slowly canceling his shifts as he sought out work nearby.

Luckily, the past decade had seen a double-digit population influx into the Lehigh Valley. Hospitals blossomed along the old coal seams like mushrooms in rot. A coffee stain on his glove box map covered at least half a dozen Pennsylvania health-care employers within a half hour of Charlie’s rented basement, each with more shifts than nurses. Charlie turned to the word processor and sent off an updated résumé. He had thirteen years’ experience at six different hospitals and—despite having left under claims of incompetence, and suspicion of worse, at nearly all of them—he could count on former coworkers to confirm his dates.
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He had a valid Pennsylvania nursing license and references still willing to describe him as an “excellent team player” with a “calm, gentle” demeanor, an employee who was “always willing to come in” for extra shifts. Communication skills? “Good.” Quality of work? “Great.” One of the first to receive Nurse Cullen’s résumé was Saint Luke’s Hospital in Fountain Hill, just down the road from Lehigh.

The hospital had been growing steadily year by year, bolstering core life-saving services while diversifying into new income streams like weight-loss surgery and sleep disorders.
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They were willing to train on the job, but experienced critical-care nurses were an especially prized commodity; when Charlie signed, Saint Luke’s threw in a $5,000 hiring bonus.
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For Charlie, this was a prestige appointment. Saint Luke’s was ranked
by
U.S. News and World Report
as one of the country’s Top 100 medical facilities, and the nine-room Coronary Care Unit was one of the jewels of that crown.
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He was going to be a star player in a star ward. Cullen dove right in, tidying his new work environment like a bird in a spring nest. “First appearances matter,” he told his coworkers.

N
ot all the nurses noticed at first.
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People die, that’s what happens in a hospital, especially the CCU, and sometimes those deaths seem to come in clusters, but something seemed to have changed. The veteran nurses felt it, a new night wind blowing their patients away. It seemed to some that the codes were almost constant now. And they weren’t ending well.

Some nurses enjoyed the action of the life-saving event, the immediacy and adrenaline, rushing in the door when the patient’s life force was rushing out. Some nurses even became addicted to it. Charlie Cullen didn’t strike his colleagues as a code freak, but when a code was called, Cullen was often the first into the room. They couldn’t help but note Cullen’s habit of hopping onto the bed, straddling the patient, and pumping away at the chest. There was little doubt about his enthusiasm. Cullen’s attitude seemed overly dramatic, but oddly without emotion.

Sure, the new hire was different, but how could you criticize a nurse for caring too much? You certainly couldn’t accuse Charlie of being inattentive, only of obsessively attending to the wrong things—such as the chairs in the nurses’ station. Every night, he’d wheel a couple of these chairs down the hall into a spare room. Every night, Charlie’s supervisor, Ellen Amedeo, would ask him to return the chairs.
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He’d sigh and roll his eyes and head off down the hall to wherever he’d squirreled them away, but the next morning he’d do it again. He seemed to be intentionally testing their patience. It was only after the shift change that anyone would notice, and by then Charlie was gone. The nurses would have to search all the rooms and look for the missing chairs so they could wheel them back again. The staff found the ritual ridiculous.