The Good Nurse: A True Story of Medicine, Madness, and Murder (3 page)

That first year of married life was a whirlwind. Charlie had been exceptionally busy—he’d received his New Jersey RN license a month after starting at Saint Barnabas, and a month later he started on another degree program at Kean College—and between school, work, and the commute, Charlie was seldom at home. Adrianne watched Dick Clark rock in the year 1988 alone with a minibottle of Chardonnay. By February she was pregnant. This was family life, the real thing, the point. But she felt her husband becoming increasingly cool with her, almost professional, as if she was one of his patients. Adrianne felt him cool down another click that fall when their daughter Shauna
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was born. Now any attention Charlie had previously given his wife was shunted exclusively to the baby. Adrianne didn’t understand the reaction—it was as if her husband had to choose between his wife and his child, as if he couldn’t broaden the focus of his affections to cover them both. Charlie was overly enthusiastic about new things—their relationship, their house, their life—but as the novelty faded, so did his affect. She had seen him lose interest in a similar way with her dogs, first with her Yorkie, Lady. Adrianne adored Lady, and had believed at first that Charlie did, too. He petted her mechanically, groomed her little ears, watched intently as she gobbled her food. Then he seemed to change the channel, and the dog no longer interested him.

He was, however, interested in the new puppy—at least, Adrianne had thought so when they’d picked it out. This was her second Yorkie terrier, a companion for Lady. She had left for work Tuesday morning, leaving Charlie with the baby and the puppy, their usual changing of the guard on his
day off. When Adrianne returned from work that evening, the puppy was gone. Charlie didn’t seem to care, and he didn’t want to help her look for it.

Charlie said that the puppy had run away. Or, that he assumed it ran away—he’d been out taking a walk while the baby was sleeping. Adrianne had to make him repeat that one—taking a walk,
without
the baby? Well, Charlie said, looking away. All he knew, he came back from his walk and the puppy was gone. He didn’t seem worried about it. He didn’t seem anything at all.

Adrianne didn’t understand—Charlie had left their infant daughter alone? And with the front door open? It wasn’t open, Charlie said, ajar, maybe, and anyway he knew the baby wouldn’t wake up. Adrianne didn’t like the way he said that.
Knew.
Had he given something to the baby? She’d had suspicions he gave their daughter cold medicine as a liquid babysitter; they’d had fights about it. He always denied it, and the discussion would go nowhere. Eventually, this argument went nowhere, too. Charlie simply stopped bothering trying to convince her of his side; he just let it drop and disappeared back into the basement. Adrianne was left feeling crazy. She didn’t understand where the man she married had gone, or why he had lost interest in all but the most perfunctory duties of their relationship. Even when Charlie was physically home he was emotionally absent. She would catch his eye by the coffeemaker, study his expressionless morning face, and wonder if her husband was still somewhere in there, hiding like a child in a darkened room. He appeared to be permanently preoccupied, fixed upon some secret scene to which Adrianne’s every syllable was merely noise and distraction. Her friends told her to be strong. Her parents advised her that marriage was a marathon, not a sprint. He’s your husband, they reminded her. And so Adrianne chalked it up to the psychic demands of mediating life and death for an hourly wage. She went to work, paid the bills, took Shauna to day care, came home. Only the car in the driveway told her whether her husband was home. Charlie was spending most of his time in the basement. She’d tried going down there a few times. She was afraid to try again. Finding him in the half dark, she had seen something. Something disturbing about her husband’s eyes. Adrianne didn’t know quite how to describe it—a cool blankness, a look that belied any feelings of love she might have imagined her husband still harbored for her. Sometimes Charlie’s eyes would drift apart, watching two separate directions, as if each eye
belonged to a separate being. In those moments, Charlie was not Charlie. Adrianne told her friends, “You know? I think maybe there’s something seriously wrong with Charlie.” Then one afternoon, proof arrived.

Adrianne answered the doorbell to find her neighbor crying. Every few weeks the neighbor’s sweet, ancient beagle, Queenie, would get out and wander down the block, and for some reason she usually ended up in the Cullens’ yard. Adrianne had brought old Queenie inside dozens of times. It got to be a sort of running joke, and when Queenie went missing, the neighbor came straight to them. But this time Queenie’s body was discovered in the alley next to their house. The vet said that she had been poisoned. Did Adrianne have any idea what might have happened?

Adrianne didn’t know what to say. She went inside to the kitchen, where the photos from PhotoMat lay on the counter, photos Adrianne had taken at day care, cute shots of Shauna with her little friends. Adrianne had come home a few days before to find that Charlie had taken a pair of scissors to each one, carefully cutting out the little boys like paper dolls in negative space. The pictures had frightened her, but she tried not to think about them. Now she couldn’t help it. The empty people shapes reminded her of her husband. She thought about the pictures and her puppy, about Queenie, and her neighbor crying at the front door. Then Adrianne started crying, too.

4

O
n February 11, 1991, pharmacy nurse Pam Allen had brought a suspicious IV bag to the desk of Saint Barnabas’s risk manager, Karen Seiden.
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The port on the bag looked used, but the bag itself was full to the point of leaking. It didn’t look right to Seiden, either. Seiden got in touch with the hospital’s assistant director of security, a former cop named Thomas Arnold. Arnold sent the IV bag to the pathology lab. The bag was supposed to contain only saline and heparin; the lab test found that it contained insulin as well.

Three days later, on Valentine’s Day, a Saint Barnabas Critical Care Unit patient named Anna Byers was placed on an IV drip of heparin. Within a half hour she was in a cold sweat, confused, nauseous, and shakingly weak. A blood lab showed an insulin level off the charts. She was given orange juice—a simple remedy of sugar and one of the fastest ways to normalize a crash if you catch it early enough. It didn’t work. The nurses were forced to give Byers an IV of dextrose, dripping sugar directly into her bloodstream. It kept Byers from dying, but she was so loaded with insulin that she crashed right through that as well. She stayed like that all morning, all afternoon, all night. Byers had a surgery scheduled for the next morning—a catheter was to be put in her heart. She was probably now too unstable to handle the procedure, but just in case, her physician ordered that her heparin IV drip be removed.
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As soon as Byers’s heparin drip was unplugged for surgery, her insulin issues abated, and she started to feel better.

By 2 p.m. she was back in her room, stable and well. Her blood sugar crash issues had vanished. Her surgical wounds were clotted. She was ready to be put back on the heparin drip. An IV was started. And soon after, Anna Byers was back on the same unstable ride again. By now her nurses were mainlining the sugar water, trying to outfeed the fire. She’d stabilize
and crash, wooze in and out. By 11 p.m. there wasn’t enough sugar left in her blood to even get a reading. Her body had burned it all, leaving nothing for her brain. She was ready to code.

The nurses unhooked her IV lines and rushed her down to the ICU. But within twenty minutes of being off the drip, Anna Byers was feeling better again.

Down the hall, a patient named Fred Belf was on the same ride. His heparin went in at 7 a.m. By noon he was throwing up onto his own chest, unable to keep the orange juice down, and the doctors ordered him dextrose, to be delivered intravenously with his heparin. The two drips ran a race, side by side, one unhinging the other, all day and all night, like a metabolic teeter totter.

By 7 p.m. the next night, the connection had been made between the bags of heparin and the side effects on the floor. Belf’s nurses unhooked his heparin drip; Belf quickly began to feel better. Gloved nurses removed his IV bag, placed it in sterile plastic, and sent it for testing.

The bag came back positive for insulin. A microscopic analysis of the exterior revealed a peculiar landscape studded by tiny needle sticks, including three on the edges of the bag. This was extremely unusual. Bags of saline sometimes get stuck by needles in the course of being connected to the stopcock and, in turn, the patient, but they never get stuck on the perimeter. It didn’t look like an accident. It seemed possible that someone had been intentionally and repeatedly poisoning IV bags in the Saint Barnabas Hospital storage room. Arnold and Seiden had two bags as evidence, and the anecdotal examples of Byers and Belf. Now they dug back through the patient records in the CCU, to see if anyone else had experienced similar unexplained insulin crashes recently.

Though they had no causality, they discovered that patients were in fact crashing with regularity. For months, codes had become so frequent that they overlapped; the CCU nurses would need to leave one to attend another. The information was anecdotal and confusing—the incidents weren’t confined to any one unit, or any one shift. But across the intensive care, critical care, and cardiac units, Saint Barnabas patients were magically becoming instant diabetics.

Laboratory work
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showed that not only did all of the “magic diabetics” have exceptional and unprecedented levels of insulin in their bloodstream, but also that much of this insulin was “foreign”—it had not been produced by the body. The insulin had been given to them.

The first assumption was that a mistake had been made—a nurse misreading a doctor’s order, for instance, or a mislabeled vial. Such mistakes happen in hospitals all the time. Arnold and Seiden studied the patients’ charts but found neither a doctor’s prescription for insulin nor a nurse’s notation that it was given. This meant that either it was a double mistake—patients being given a nonprescribed drug, and the nurse then accidentally neglecting to complete the chart—or it wasn’t a mistake at all. Either way, they had a problem. Arnold took his findings to his boss, the head of Saint Barnabas security and SMBC vice president, Joe Barry.

In his previous life, Joe Barry had been a decorated and much respected thirty-year police veteran and former major with the New Jersey State Police. Now as senior vice president in charge of security at Saint Barnabas, Barry was charged with the delicate investigation into the potential murder of patients. With their combined experience, Arnold and Barry were uniquely qualified to conduct a sophisticated investigation such as this. After ruling out the patients’ own visitors, the only possible suspects left were the hospital staff. Arnold and Barry compared the nursing work schedules with the times and dates of the patient codes. Only three nurses were working every code. And of these, nurse Charles Cullen interested them the most.
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Arnold had already interviewed several Saint Barnabas staffers about the insulin incidents.
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Each nurse had seemed nervous, concerned for her job and reputation and the patients involved. Only nurse Charles Cullen didn’t appear worried at all. In fact, he was pointedly
not
worried, about anything. To Arnold, it didn’t seem to just be a “Who, me?” act. Cullen genuinely didn’t seem to care. In fact, he was defiant. Arnold had tried several times to schedule Cullen for a sit-down meeting, but the nurse was employed by a staffing service, rather than the hospital. His shifts were erratic and varied, making Cullen difficult to pin down. When pressed, Cullen always made it clear that he was busy nursing, a responsibility “more important” than Arnold’s crass intrigues. When Arnold and Barry finally got Cullen into a conference room for the sit-down,
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the nurse refused to answer any questions. He sat there in the rolling chair, arms crossed, studying the linoleum. The attitude alone was a red flag to the ex-cops, and Arnold told him so.

“I know you’re putting something in those bags,” Arnold told him. He was shooting from the hip, he couldn’t prove anything, but his gut told him, absolutely, this guy was dirty. “You can’t prove anything” was Cullen’s
reply. That struck the investigators as the wrong response for an innocent man—and not very smart, either. As former cops, Arnold and Barry read it as a
fuck you
. His defiance pissed Arnold off, made it personal. But Cullen didn’t seem to care about that, either. “I don’t need to talk to you,” he said, and walked out of the interview.

Arnold and Barry had seen this type of behavior as cops on the street, but never at the hospital. Parking lot dings, gift-shop shoplifters, or unruly responses to the posted visiting hours—those were the norm. Sometimes they had a nurse on the hot seat, but usually it was a secret doper pocketing Percocet or Vicodin, then cheating the charts on the tabulation. Addicts were the same everywhere, their motives simple and direct. But something darker seemed to be at play here. There was no imaginable motivation for the randomly poisoned bags of saline in the storage closet or the misadministration of insulin. Nor could Arnold come up with a reasonable explanation for Cullen’s reaction—the guy didn’t seem at all rattled by the accusations. Or even surprised. He had a dead look in his eyes that Arnold recognized and didn’t like. The most disturbing part was that Charlie was correct; he didn’t need to talk to them. Arnold and Barry’s investigation would need to do Cullen’s talking for him.

Arnold and Barry tasked the staff with helping create time lines and mortality rates during the window of nurse Charles Cullen’s employment as he floated between the ICU CCU and Cardiac Care units. It seemed like the deeper they dug, the more questionable cases they found.
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But what they didn’t find was absolute, case-making certainty. The patients all had a complicated symphony of diseases and symptoms, and there was no way to connect their unexplained or spikes in insulin directly to one event, or to Charles Cullen, or, in several cases, to their eventual deaths. It was entirely possible the facts were coincidental. And because Cullen was a floater, and many of his shifts were unscheduled callins at the last moment, cross-indexing Cullen’s actions with the problems on the unit was all the more difficult. If they were going to take the investigation to the next level, they’d need outside help. It was time to alert the police.