The Good Nurse: A True Story of Medicine, Madness, and Murder (8 page)

Charlie very much wanted to keep his kids, especially now. His young children were the unquestioning fans of a certain select version of himself. They were dependents, just like the patients under his care in the ICU. He believed that in time he might actually become the man that his children imagined him to be: A caring father. A good friend. A compassionate caregiver. Some people saw him that way. Some of his fellow nurses saw him that way. His mother had seen him this way. Adrianne had, once, and so had Michelle. Maybe, he thought, if he kept his kids, he could make them love him; they’d seen him this way, too. If Charlie was satisfied by their attentions, he might not be willing to risk losing them again. Maybe he’d have no reason to keep dosing patients at the hospital, such as Ms. Natoli. Charlie would be the good father and the good nurse, an outcome he believed George and the family court should want. George’s recommendations held the key to this potential future, and so Charlie was always sober for their mandatory interviews.

Of course, George had no idea that Charlie was killing people. But he was very much aware that Charlie was regularly attempting to kill himself, or at least making grand gestures at it. George noted in Cullen’s file that suicide was “the most severe and ultimate form of abuse/neglect, rejection, and abandonment one could inflict on one’s children.” Later that week
Adrianne’s lawyer used the report in family court. Combined with a host of other evidence regarding Charlie’s drinking, the police calls, and Adrianne’s concerns that if Charlie was left alone with their daughters, he would “impulsively take his life and theirs.” Charlie had no standing in the courtroom. The only arena in which he still had gravitas was in the hospital.

13

September 1, 1993

H
e didn’t know what he’d do, exactly, it wasn’t a decision, but he had been visiting the ICU lately, and he was zeroing in. A Mrs. Helen Dean was scheduled to leave the hospital the next day. She was an elderly woman recovering well from breast cancer surgery, and she had an adult son, Larry, who seemed never to leave her bedside. Something about that detail forced Charlie’s decision.

The digoxin was in small glass ampules in the hospital drug closet, loaded into a plastic drawer called a cassette. Digoxin is a common drug on the ICU, called “didge” by the nurses, and written quickly on charts as “dig.” A pharmacopeial relative of the Foxglove extract digitalis, dig was used in the hospital to slow the firing mechanism of the heart muscles. Charlie loaded three amps, thinking,
Three times point-five mills, that’s a milligram and a half; intermuscular, it could be enough.
He palmed the syringe as if he were doing a magic trick, and walked into the room.

T
he way Larry Dean remembered it,
¹
he was sitting at his mother’s bedside when the male nurse entered. Immediately, something struck him as odd. Larry had been at the hospital every day since his mother had come in. He knew all the nurses, at least by sight, and would especially remember a male nurse. He’d never seen this guy. That was strange, but stranger still was that this nurse was dressed entirely in white, like an ice cream man. Every other nurse he’d seen at Warren was dressed in blue.

The nurse in all white told Larry, “You’ve got to leave the room.” The nurse said this without eye contact or facial expression. So Larry did what he was told and headed down the hall for a coffee. He returned ten minutes later to find his mother, alone and angry. “He stuck me,” she said.

Helen Dean pulled up her johnny and pointed to a spot on her inner thigh. Larry had his Swiss Army knife, the deluxe kind with the little magnifying lens, and sure enough, there was a pinprick. So Larry called the doctor.

“It could be a bug bite,” the doctor explained. But by the next day, Helen Dean was violently ill. She was sweating, exhausted. When her heart stopped, she could not be revived, and Larry could not be consoled.

Larry Dean knew right away that something wasn’t right and took it upon himself to investigate. He complained to his mother’s oncologist, who confirmed that Mrs. Dean hadn’t been scheduled for any injection. He complained to his mother’s other nurses. They told him that the male nurse his mother had identified was Charles Cullen.

Larry Dean’s next call was to the Warren County prosecutor. He said his mother had been murdered, and told them who had done it.
²

A
fter injecting Helen Dean, Charlie had driven home and thought about his actions of the evening. He didn’t much dwell on it; he simply assumed that this time they’d figure it out. Wouldn’t they? Maybe it depended upon whether Mrs. Dean was dead. He went in to work the next day, and he was surprised it had taken twenty-four hours
³
but, yep, she was dead. And yep, they were figuring it out. His work schedule was crowded with meetings about the incident. He was questioned by the doctor, the Warren administrators, his nurse supervisors, and two people from the Warren County Prosecutor’s Office, Major Crime Investigation Unit.
⁴
Each wanted him to run them through the scenario aloud. Charlie denied everything, of course, including the injection. He watched as they searched his locker. Meanwhile, Helen Dean had been wheeled into cold storage, then thawed. A doctor from the Medical Examiner’s Office sampled the tiny injection site on her thigh. The medical examiner would test for nearly one hundred potentially lethal chemicals. But for some reason, they neglected to test for digoxin. Helen Dean’s death was determined to be of natural causes.
⁵

Meanwhile, Charlie’s supervisor informed him that he would be put on indefinite paid leave, effective immediately. That didn’t sound so bad, being paid not to work, until he sat home in his basement apartment, thinking, depressed, wondering if they’d come for him or if he should set it up so
he could be a tragic suicide in jail, as he had after breaking into Michelle’s apartment. He had nothing to do and all day to do it, sitting on the couch until the TV numbed him, moving to the kitchen table, the bed, the couch again. The stove clock piled up the seconds:
tchuckk tchuckk
. The ambulance arrived just before 11 p.m. This time, Charlie left the door unlocked for them.

14

C
harlie tumbled through the suicide cycle: emergency room to inpatient Psychological Hospital
¹
to outpatient counseling program. He popped out the other side to find the Warren County Prosecutor’s Office waiting. They did the usual interview. He denied everything. When the questioning ended, they brought in a polygraph.

The wires connected his body to the machine. Inked needles scribbled the results on the graph paper, showing the spiking of the ORS complex and frequency of the P wave. Charlie knew that the spikes could be moved up or down, even stopped altogether. Changing those spikes was what he did for a living.

The police didn’t know medicine and didn’t care about what the spikes and troughs really meant. They were interested in the most basic changes, pulse and rhythm. On the basis of this, they accessed what they called the truth. Charlie called it something else. Charlie knew these were changes you could control with digoxin, beta blockers, nitroprusside.

The polygraph made gross assumptions. It ignored the most fascinating arenas of the EKG. It connected the truth in a man’s head and the action of his heart, running a string from one to the other like a child’s tin-can telephone. It was a stupid test, and Charlie passed it with flying colors. But personally, Charlie was pretty sure they knew the truth.
²

C
harlie’s paid leave from Warren Hospital lasted him into the New Year, but he’d already decided not to go back. He would need another job if he was going to make his child support payments, especially at the high sum the judge had based on his eighty-hour-a-week work schedule. Charlie found it at Hunterdon Hospital, a pretty little nonprofit medical center in
the boutique town of Flemington, New Jersey. The numbers of both Warren Hospital and Saint Barnabas Medical Center were provided as potential references.
³
By April 1994, Charlie was making $23 an hour plus overtime in the Hunterdon Hospital ICU, and living up to his recommenders’ reviews.

His October 1995 performance report from Nurse Supervisor Marjorie Whelan called him “a patient advocate… cares about his patient’s welfare… organized, very giving of his time, so much to offer, very bright, witty & intelligent.” He started dating Kathy, another nurse on the ward, unhappily married, apparently available, three kids. He was sated by her attentions, rather than those of the hospital, and that winter he received a photocopied certificate filled in with his name in magic marker from the Hunterdon ICU. “To Charles Cullen, in appreciation for ‘Grace Under Fire,’ ” it read. “For all the night shifts you helped out on, thanks!” Marjorie Whelan went further. “Charles is always positive and polite! An excellent patient advocate! Helpful!” she wrote. “He has no medication errors.”

But in fact, he did.

The change came as imperceptibly as twilight becomes night. It wasn’t a conscious choice—he couldn’t say exactly when or why—but as 1995 wore on, Charlie went dark. By November, the man who showed up to work each evening bore little resemblance to the dream nurse Hunterdon had imagined they had hired.

He didn’t really remember the names of those he injected and killed,
⁴
no more than he cared about the reprimands and write-ups now thickening his once-perfect personnel file.
⁵
Some nurses complained that Cullen was “over-lubricating his patients,” turning them into “grease buckets” after he bathed them alone with the blinds drawn. The practice struck his coworkers as unprofessional, bordering on creepy, but his litany of medication errors was far more serious.
⁶
Charlie was caught administering unprescribed drugs to some patients and withholding essential prescribed drugs from others. Nurse Supervisor Whelan couldn’t explain this sudden turn in her star employee or his new, bizarre behavior, but she grew concerned enough to pull Cullen’s patient charts. These weren’t normal mistakes. Whenever Nurse Cullen gave the wrong drug to a patient, he also failed to record that drug on the chart. The nurse was playing doctor as no doctor would. Nurse Cullen was even ordering his own lab tests. The requests were bizarrely specific, as if he was looking for something in particular.

On the morning of July 19, ten days after Charlie had killed the elderly Jesse Eichin with a dose of digoxin, Whelan pulled Charlie into an empty room for a conference. She couldn’t make sense of the disturbing pattern she saw, so she presented an ultimatum. One more incident, Whelan said, and Charlie would be terminated.