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?”6
“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.7
18
April 2000
Charlie 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.1 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 patients2 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.3 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.4 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.5
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.6 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.
Not all the nurses noticed at first.7 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.8 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.
There seemed to be no sense to it. It was almost as if Charlie was playing a game.
19
February 2001
It 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.
On 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
It 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.
Thelma 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, o
f 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
The 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 waste2 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.
Wolfe left the closet to find Gerry Kimble and Candy Wahlmark at the nursing station. Gerry was the veteran here—he’d been in that unit sixteen years. He marched down to the med room expecting that the younger female nurse was eeking at a mouse but, yep, there was something in there. Gerry got on the phone.
The sharps box is like a drop mailbox; only Environmental Services had the key. They unlocked it, and Gerry upended the box into a bedpan. He and Candy brought the pile into a spare room, on a mission now. They carefully picked the drugs from the needles, lining them up on the counter.
The Good Nurse: A True Story of Medicine, Madness, and Murder Page 8
