The Good Nurse: A True Story of Medicine, Madness, and Murder (12 page)

There seemed to be no sense to it. It was almost as if Charlie was playing a game.

19

February 2001

I
t had been thirteen years since Charles Cullen had been a former Navy man in an all-girl nursing college, and the world had changed. Now there were women serving in the Navy, and many men working in the nursing station. Charlie didn’t like this dynamic. He found the male nurses mean, uncaring, cold. Charlie rarely spoke to them, and he doubled his attentions toward some of the young female staffers at Saint Luke’s. Julie,
¹
in particular, he liked a lot. Charlie started leaving her little presents at the nurses’ station, “from a secret admirer.” It was cute at first, but as the gifts piled up daily, the “secret admirer” thing got creepy. So finally, Charlie signed a card: “To Julie, from your admirer, Brian Flynn.” The nurses ate it up. Who the heck was Brian Flynn?
²
It was all they talked about at the station. Charlie was being the anonymous center of attention. Overhearing the gossip, he burst with pride. Finally, when he could contain himself no longer, he admitted it was him. But the revelation didn’t elicit the reaction Charlie was looking for. The men laughed at him, and the women seemed afraid. All the highs he’d experienced as Brian Flynn were mirrored in the lows of being himself. Charlie felt rejected, humiliated. He was so much more being anonymous. There was power in that role. Anonymous could deny; anonymous could disappear. Anonymous was an unapologetic mystery, godlike in control.

O
n many of his shifts Charlie was teamed with three other males, Joe and Brad and the other one, Charlie wasn’t sure of his name. He disapproved of their working styles, like the way they put diapers on the patients rather than walk them to the toilet. It was unprofessional. He preferred, whenever possible, not to be scheduled with the men at all. But this night, they
called him at home. A new patient was en route, a transfer, and they needed Charlie to come in. So he slipped into his scrubs and hit the highway. By the time he arrived, the new patient was in bed, and his male coworkers were complaining.

She was an elderly woman, very sick, transferred from another facility. She’d arrived by ambulance. It was the sort of patient the nurses called a “dump.” She was going to die. She’d already coded twice during the ambulance ride over. It was only a matter of time. Charlie knew that the dump was a tactic—offloading the terminal patients was one of the means a hospital or nursing facility could use to keep their mortality rate low—one of the ways you get into
U.S. News and World Report
’s “Top 100 Hospitals” list. Saint Luke’s was Top 100 material;
³
the CCU nurses were proud of that. But dumps screwed the numbers.

He later remembered the nurses laughing at this old woman, like it was a party. He remembered how her doctor had come to the hospital, trying to justify to the family why they’d transferred her at all, why they’d put her through the ambulance ride and the code, what they could possibly do for her at Saint Luke’s that they couldn’t do at the previous hospital, which, Charlie thought, was nothing, nothing at all. This was what they called the Code Conversation. Charlie knew it cold, and he was good at it. Families didn’t want to face reality. But they needed to.

Meanwhile, the guys had started playing Hacky Sack with a ball of tape.
⁴
He understood the need for gallows humor—that’s normal on a unit. You don’t cry over the dead. But you don’t play Hacky Sack, either. For that matter, you don’t play with the nitroglycerine, which the unit stocked to be used for patients as a heart drug, not so these male nurse fools could goof around and smash the stuff outside against the parking lot to see if it explodes.

Charlie saw two potential paths for the dump. Tonight, he took what he thought of as the direct route, injecting digoxin right into the piggyback port of the old woman’s IV. The piggyback is just an extra onramp into the IV line; nurses inject into it all the time, usually sterile saline, what they call “flushing the line.” Injecting into the line was totally legitimate action, not suspicious at all. If someone were to walk in on him, that was what he’d say he was doing. The dig is clear, same as saline. But nobody comes in. The rooms are private. One-on-one care is one of the selling points of this Top 100 unit.

Afterward, Charlie placed the vial and the used needle in the sharps box
and left the room for the nurses’ station. Straightening. Hovering. Busying himself. Putting the chairs away. Until the code finally came, and he was right on it, a captain, the code leader, trying valiantly for the save.

Later, after the woman has expired and her family has gathered to mourn, Charlie can still hear the guys carrying on with the stupid tape ball. But for now he’s done. She was his only patient. He’s allowed to leave. He headed home. He’d been working on a project—a hobby horse he was carving for a pregnant nurse named Jane. The guys on the unit had been picking on Jane, too, Charlie felt. Charlie wouldn’t do that. He wanted her to know. Maybe he’d even present it to her anonymously.

20

I
t was spring when the Saint Luke’s nurses noticed that their meds were missing.
¹
Not all the drugs, of course, just one which for some reason they stocked heavily, but hardly ever used: Pronestyl. Every afternoon they restocked it in the med room. Every night it was gone. For six months it was a head scratcher. The nurses joked about it—somebody must be using the stuff as fertilizer!
²
Nobody knew what was going on, but neither did anyone investigate it.

Which was a disappointment to Charlie, because he’d been sending a message. For months he’d been throwing the drug away, every day he worked. He had decided that he truly didn’t like Saint Luke’s Hospital. He felt that a Catholic hospital should be better behaved. He sincerely believed Saint Luke’s was still a world-class institution, a good place to get better if you had to be in the hospital at all. But Charlie didn’t like the attitude there. He kept putting the chairs away and they kept bringing them back. And the lotion—he used it heavily here, too, and his supervisors wouldn’t leave him alone about it. It was his way of needling them. He’d go into a patient’s room, use the lotion, see the bottle of talc on the sill, and throw that away, too. They’d give him hell about the lotion, so he had his war with their powder. He sometimes saw the absurdity of all this. He was a lapsed Catholic at a Catholic hospital. He had renounced the religion of Christ for marriage and children, then lost the marriage, then lost the children. So where did it leave him? As an Irish Catholic Jew working for Saint Luke, the first Christian physician. Patron saint of doctors and surgeons, bachelors and butchers, painters and sculptors, too. Throwing away medicine, costing the hospital money—by his calculations hundreds, maybe even thousands, of dollars—was simply something he could do. It was his means of communicating, taking another indirect route. Part of Charlie figuring,
They’ll know, they’ll figure it out, they’ve got to,
like it was a test, an act of faith. But part of him they wouldn’t see. Until, suddenly, they did.

T
helma Moyer, the day charge nurse, noticed that the Pronestyl seemed to be running out “in spurts.”
³
In April 2002, Moyer mentioned it to her supervisor, Ellen Amedeo, and the hospital pharmacist, Tom Nugen. Nugen checked his records but couldn’t account for the disappearance. Amedeo took all this in, but didn’t do more.

June 1, 2002, was a Saturday, a day that could run hot or cold for Charlie, depending on his mood and the custody arrangement. Good weekends were when the kids were visiting and glad to see him. He was happy poking around the little garden plot out back and selecting flowers for his girls’ hair, or spending an afternoon working through the Dairy Queen menu, anything they wanted. This happened to be one of the bitter weekends. The afternoon was humid, and the forecast called for rain. He’d waited for it all day and it never came. Which was typical. They say it’s going to rain and, of course, it never does. They don’t say anything and it rains for a week. He dressed for work not even knowing whether to bring a rain slicker or not.

The drive to Saint Luke’s was a straight shot west on and off Route 22. He was in the lot by 6:15 p.m., in the unit by 6:20. Night shifts didn’t start until seven o’clock, but he liked to be early. He dropped his coat and changed his shoes in the men’s locker room. Nobody else used it at that hour—another reason for being early to work: you could urinate without anyone hearing you or looking at your privates, no boyish chitchat, no locker room hazing. Outside the doors, the CCU was humming with activity, visitor hours still in effect, the unit full, the nursing station abandoned.

Charlie went into his routine, messing with the chairs, but keeping his eyes on the monitors. Each monitor corresponds with a name, a room number, a bed, a life. He’d been watching. But Charlie wasn’t exactly sure of tonight’s program. Then he gathered up the medicines the pharmacy runner had dropped off for the night shift, walked them down the hall to the med supply room, punched his code, and closed the door behind him. He was alone. There was peace in enclosed spaces: basements, boiler rooms, bathrooms. The sudden dark smarted with sparks. Charlie flipped the light and got to work, only then deciding he’d take the indirect route.

The indirect route was impossibly subtle. Nobody questions. All the other nurses see is that Charlie is being helpful, stocking the drugs in the med room. Later, he’ll be helpful in setting up the lines for his fellow nurses, assisting the start of a new IV. Later, they see him helping again, with the code. They never connect the three. There was no rational reason to connect them. He didn’t have to hide, he didn’t need gloves. He just pulled a 10 ml syringe, popped it from its candylike wrapper, unsheathed the hollow little needle,
pop-pop
, in and out of the saline. Then, switched bags,
pop-pop
, into the IVs. He dumped the now-empty vials and the used syringe into the metal sharps container, then gently laid the finished antibiotic cocktails into the named patient trays. Charlie was about to flip the light again when he noticed the Pronestyl, on the shelf above. It was back, stocked full. Back like the chairs.

Charlie couldn’t believe it. They push and he pushes back. It’s like yelling your throat bloody and nobody’s listening. So he’ll keep yelling. Not really yelling, of course. He wouldn’t yell. But he will be heard. He flipped off the light and hurried back down the hall. And when the next shift came on at 7 a.m., there would be a couple hundred dollars’ less medicine in the med supply closet, and fewer patients breathing in the CCU.
⁴

21

June 2001

T
he rain came finally with morning. It stayed through the shift change and kept on through the afternoon, when a thirty-one-year-old CCU day nurse named Kim Wolfe stepped into the med storage room to draw her IVs.
¹
She finished with the needle and stuck it into the sharps box, same as always. Usually, the needle clinks on the bottom of the box. This time there was no clink. The used needle wouldn’t even fit into the trash.

Nurses don’t have much reason to open the sharps bin, digging into dangerous drug garbage. Since AIDS had upped the ante on hepatitis, risking needle-sticks was strictly a job for Environmental Services—biohazard garbagemen who collected the needles and other medical waste
²
and whisked it off to another piece of New Jersey for incineration. But Kim was curious. She lifted the lid and peered into the hole. Instead of used sharps, she saw white cardboard boxes.