The Good Nurse: A True Story of Medicine, Madness, and Murder

by Charles Graeber

  “Ay-mee,” Annie said. “I just wanted to let you know. They’re asking all kinds of questions about you, over and over, they’re—”

  “Who is, sweetie?”

  “The detectives. The investigators, they’re here. They’re asking everybody.”

  “I know they are.”

  “Every single person, over and over and over, ‘Amy Amy, what about Amy?’ ”

  “I know,” Amy told Annie. “Don’t worry. Everything is going to be okay.” Not that she was quite sure of that yet herself.

  The detectives registered Amy as a “Consensual Confidential Informant approved for audio intercepts, both telephonic and body,” and provided Amy with a room in the prosecutor’s office. But after her first taped phone calls, Amy found it more comfortable to talk from her living room couch. In between work and sleep she sat up with a stack of printouts, turning pages, making notes. The pages told a story. It was far more frightening than she’d ever imagined.

  Tim and Danny had asked her to concentrate on Reverend Gall—they had their case there. Amy saw the lab reports from the State Medical Examiner indicating that Gall’s cause of death was overdose by digoxin. The Pyxis showed that Charlie had withdrawn digoxin the day before the reverend coded and died. That might have been a coincidence, if it had been the only thing wrong. But there was a larger pattern. It would take Amy weeks of poring through the papers to fully appreciate it.

  The Pyxis hadn’t been entirely revealing to Tim and Danny—Danny had seen some patterns, but the Latin names were mostly just a list of unpronounceable words. The detectives had chiefly looked for the drug names they knew and the dates they’d been given. The rest was just noise. But Amy knew the drugs, and she knew ICU nursing. And from a nursing perspective, Charlie’s drug requests made no sense.

  On page after page, night after night, Charlie Cullen was ordering drugs his patients couldn’t possibly need. He was withdrawing rarely used drugs in absurd quantities and with alarming frequency. And, according to the paperwork, Charlie was doing something that made even less sense. Over and over, Charlie was ordering drugs, then canceling the orders. The night Gall died, for instance, Charlie had ordered then canceled digoxin. As far as Pyxis was concerned, Charlie had never withdrawn the drug. And yet Gall had received it, and died.

  One cancellation in itself wasn’t a big deal. Every nurse makes the occasional mistake. But mistakes didn’t look like this. Charlie was making the same errors on a nightly basis, sometimes even hourly. It seemed like a system—as if he was making errors on purpose.

  Meanwhile, Amy was increasingly making mistakes of her own. She was exhausted from the double duty of moonlighting as a CI after working shifts on the CCU, and near the end of her Sunday night shift, she realized that she’d punched the wrong drug order into the Pyxis. Great, she thought. With the detectives spreading suspicions about her in the hospital, even innocent mistakes might get her fired. Amy hit Cancel on the order, just as the drug drawer popped open.

  Amy looked at the screen—it was canceled there. The record would show that she had not taken the drug out. She did it a few more times to be sure. Then she called Tim. She came in the next day, fanning the paperwork across the desk to show them how it worked.

  Amy went back through the paperwork, showing Tim and Danny where Charlie had called up a drug and canceled it, over and over. In thea s, the Pyxis drug drawer had opened for each of those cancellations. Cullen could have taken the meds without acknowledging it in the records. Amy showed how Charlie had called up and canceled dig at least twenty-seven separate times between when he started at Somerset and June 27—eight times in the month of February alone. None of the other nurses in the unit had ordered even a fifth of those numbers.

  It was a good thea s, impressive, if circumstantial. Could Tim and Danny prove Cullen was stealing drugs through canceled orders?

  50

  Amy took a bath and slipped into her oldest and softest pajamas. She laid out by the fire, pretending to relax with a book. When that didn’t work she put down the wineglass and picked up the phone. Charlie answered on the second ring.

  “Hi, Charl!” Amy said. She couldn’t believe it—she was genuinely glad to hear his voice. “How’s it going?”

  “Okay…,” Charlie said.

  “Okay?”

  “Okay. Not, you know, I mean—it’s just getting me more and more worried,” Charlie said. “Because you know, again, like I said, it’s been a couple of weeks of it. And you know everything is sort of a… I feel like everything is closing in on this.” His girlfriend, Cathy, had told him not to worry, that everything happened for a reason, that God took care of things. But sometimes, Charlie knew, you had to take care of things yourself.

  But Amy wasn’t like Cathy. “You know,” he said. “You get me.”

  “Has she been that supportive, though?” Amy asked. “I mean, she’s really saying, ‘Don’t worry’? I mean, she was being so horrible before.”

  “I think she realizes that, you know, I’m not in a really good space,” Charlie says. “But then, we did get into a major argument a couple of days afterward. You know, and that had to do with—a guy from where she works wrote her actually like, a romantic letter. And—”

  Charlie had already told her about his girlfriend’s “friend.” “Is this the guy that bought her like lunch or something?” Amy said.

  “They had dinner,” Charlie said. “And, ah, she went upstairs for dinner up at, you know, on his floor and stuff. And he, he wrote some weird letters that were, you know, complaining about the night he worked there, when she wasn’t there. And then he wrote—I mean, ‘You know you have to restore my soul, you have to—’ ”

  “What?” Amy shrieked.

  “You know, ‘you have to,’ you know, ‘lighten my heart’—all this weird stuff,” Charlie said.

  “Oh my God,” Amy says. “Didn’t you want to puke?”

  “Well, she, like, kept it with her other personal papers and stuff,” Charlie said. Charlie had come across the note while he was packing her a lunch. He’d confronted Cathy, but Cathy was indignant that he’d been snooping. She’d told him it was a joke. Then Charlie found another letter in her purse. Their fights were just pinwheeling now.

  “We got through that, it’s been okay since, as far as I know,” Charlie said. “I actually went over to his house to ask him about it and—”

  “You went over to his house!?” Charlie was a trip. He was stalking his pregnant girlfriend’s boyfriend.

  “Yeah,” Charlie said. He sounded to be enjoying the story. “Well, see—the weird thing about it is—and this is part of the whole weird thing, um, he—”

  “Wait—you know him?”

  “No,” Charlie said. “But, um, he actually lives in the house where she used to live, which is another weird coincidence. The exact same house on the street—not the block, the exact same house that she used to live in.”

  “Okay, Charles. That’s fucked up.”

  “Well,” Charlie said. “You know. She’s saying it’s some weird coincidence.”

  “No, that’s not a coincidence,” Amy said. “You know that.”

  “Well, that’s the way I thought about it,” Charlie said. “But she’s still saying it. I mean, I don’t know how, this is just, just weird stuff. But since my life is a series of weird stuff lately, I’m getting used to it.”

  “Um-hmm,” Amy said.

  “Because,” he reminded her, “you know, I’ve gone through some minor depressions, and, ah—”

  “Minor?”

  “Well…,” Charlie drawled, stretching the moment.

  “Come on, Char.”

  “I’ve, you know, well, been feeling—suicidal. But I’ve worked through that—so far. But—”

  “Honey!” Amy said. “Are you really?”

  “I’m scared right now,” he said. “I don’t see how it’s gonna work out. And especially if they still think that I had something to do with the patient deaths. ’
Cause I, you know—I have two children already, and have one more on the way…”

  “Which is all the more reason to keep it together,” Amy said. “How about seeing somebody, how about getting an antidepressant?”

  Charlie sighed. That wasn’t a conversation that interested him. “You know, I mean—I thought about it,” he said. “But, you know—I don’t know why all of this is happening right now. I’m hoping it will all work out. But I’m, um, very scared of my own future. You know, I guess—it’s just the holidays coming up too, because I haven’t told my ex-wife yet.” Charlie was behind on his child support. The only bright spot of the week had come when Child Services called and offered him a reprieve. Charlie had no idea that it had been orchestrated by homicide detectives: They didn’t want Charlie looking too hard for work and finding it in another hospital.

  “You know, but they’re saying, ‘Okay, you’re trying, so we’re not gonna issue you a warrant for nonpayment.’ Which is nice of them, so far. But I haven’t had a lot of self-confidence lately,” Charlie explained. “You know, if I had more confidence in myself, maybe, I would be more joyful about the whole relationship, about what’s going on, but…” Charlie drifted back into his problems with Cathy again, the new man he saw waiting wolfishly in the wings. What did she see in him? “I mean, I met him, he didn’t strike me as anything, you know, really spectacular.”

  “Well,” Amy said. “He’s not smart like my Charlie.”

  “Yeah,” Charlie said. Amy always knew what to say.

  That night, Amy had a dream. Charlie was back at work. She watched him load the needle, inject it into an IV, and as the plunger pressed home Amy felt a surge of adrenaline. It was her pressing that syringe. She was the killer. And she was enjoying it.

  But then Amy was the patient. She lay in the hospital bed. Charlie was there. He stood at the end of the hallway, where she had so often seen him, the portable Cerner cart in front like a pulpit. Charlie was talking, but Amy couldn’t understand, and she couldn’t answer. In a panic, she realized that she couldn’t move at all. It was the injection. She’d been paralyzed. She was still paralyzed when she woke up. She checked her heart, feeling it flutter under her palm like a live bird. She didn’t need to look up the nightmare in her dog-eared dream books. This was a no-brainer to interpret. She felt unsafe, powerless, she knew that. But there was something else in there, too. It wasn’t until she’d finished breakfast and had the house to herself that she was able to puzzle out the rest.

  What had bothered her was where Charlie had been standing—his usual position at the end of the L-shaped hallway. It was an isolated spot, closest to the doors to the elevator, farthest from the nursing station. She’d never much thought about it before. Now she wondered why.

  Amy lay back on the couch and closed her eyes. She’d used this method hundreds of times before, a sort of self-hypnosis that she’d learned for confronting the painful episodes from her childhood. She’d breathe and disappear. It wasn’t remembering so much as reliving.

  She could place herself on shift, back with Charlie. She saw Charlie in the corner of the CCU. He was cute, in his shy, drippy way, hiding behind the computer. Every day after report, he’d wheel the portable Cerner computer away down the hall. He reminded her of a sad little mailman in his cardigan, towing his cart away. She had always assumed he wanted to work in quiet. She hadn’t considered that he wanted to be by the doors to the hall. But that was where the drugs came in.

  Standing by the doors, Charlie was the first and often the only person to see the runner from the pharmacy. Charlie always caught the runner; he was helpful like that. He always relieved the runner of his delivery tote of drugs. At the time, it had seemed like Charlie was the nice guy, saving the runner a trip, stocking the unit, doing his busy work. Now she saw something else.

  My God, Amy realized. Charlie didn’t have to touch the Pyxis system at all.

  51

  Amy pored through the paperwork that night till her eyes cracked. She brought the paperwork to bed with her, fell asleep with it, and read it in the morning before heading out for the long commute south, to use the Pyxis herself, another long weekend of overnight shifts.

  Amy tried not to think of herself as being a traitor, but every day, it was more difficult. She had broken rank and felt unbearably at risk of being fired by the very institution she was working to improve, and utterly alone in the stress of that. She was still a nurse, but only the detectives understood her full identity. Tim and Danny were almost always working late now; Amy would swing in after her shift, share a coffee while handing off another stack of paperwork. Seeing the detectives working made Amy feel a little less alone, a little more brave.

  It had been Amy who first told the detectives about the Cerner patient records. The SCPO investigators would want those records, unmolested and in full. Detective Douglas Brownlie had started the paperwork for the subpoena. Meanwhile, Amy had another way.

  She felt something like the guy in that Johnny Cash song, the one where the auto worker brings a new car part home in his lunch box every day for twenty years and ends up with a full Cadillac. Except Amy didn’t have twenty years to pull all of Charlie’s Cerner records without anyone noticing. Instead, she brought a bigger purse to work.

  Apparently, none of her coworkers had noticed how lengthy her Cerner printouts had grown; the privacy of the night shift afforded such liberties. Amy read through them quickly on the screen during her shift, then thumbed the pages, more slowly, alone in the car. She told herself it wasn’t suspicious—a nurse, in a nurse’s scrub uniform, parked by the roadside reading medical charts, but she knew it was suspicious, of course it was. These days, she seemed suspicious even to herself. She was trying to track Charlie down, figure out his methods of murder, if in fact he was a murderer. But in the process, she was acting like Charlie, too.

  The slide between the Friday shift and the Saturday shift was easy: out by 11:00, home by 1:30 or 2:00, and a whole Saturday with the kids before heading back for the overnight. But by Sunday she was always exhausted, this Sunday more exhausting than most. Amy sat at the nurses’ station for report, feeling like an imposter. She didn’t trust herself tonight. She was nursing in a crime scene, but too tired either to nurse or investigate. Working with the prosecution had made Amy skittish. She was scared for everyone now, including her patients and herself. The stress soon crystallized into a splitting headache.

  Amy walked to the Pxyis machine to order up a Tylenol, then just as quickly stopped herself. Everything was so loaded now, even the most usual things. Even pulling out a frigging Tylenol in a hospital.

  Nurses called it self-dispensing. You wouldn’t really call it a secret, but it wasn’t exactly in the brochure. When a nurse needed an aspirin or a Tylenol for herself, she would often pull the med out of the Pyxis machine. It was a little thing, like a waitress eating a French fry off a plate. Amy fretted over her karmic bank balance daily, but had never been bothered by this. So why the huge guilty rush? Now she was angry with herself—it was just a Tylenol, for chrissake, so her head didn’t fall off while she worked her ass off on the overnight. Amy decided, Screw it, she’d work with her teeth gritted.

  Amy pressed Cancel on her Pyxis acetaminophen order. Of course, the drawer popped open anyway, and she instantly thought of Charlie as she bent to shut it, and another guilty wave twisted up her breathing. And then she stopped, and looked. There was the Tylenol, in its little cassette. The dig was in the same drawer, practically neighbors.

  It would be that easy. As she went back through his Pyxis requests, it all began to make sense to her. The information had been in the computer the whole time. He wasn’t always ordering dig; he didn’t have to. He could order Tylenol. The dig was in the same drawer.

  After her shift, Amy returned to the beginning of the Pyxis stack. The detectives were trying to convict Cullen for the murder of Florian Gall, focused on him and the dig. The problem was, the dig orders didn’t match up with the dig de
aths. But the Tylenol orders did. Maybe there was no way to prove he’d ordered one thing and taken another, but no nurse would look at his pattern of Tylenol orders and not find it bizarre. Amy couldn’t help wondering if she was the first at Somerset to notice them.

  The Tylenol orders weren’t the only odd pattern. Studying the Pyxis again, Amy found other curious combinations of drugs that Charlie had consistently ordered. Nitroprusside. Norepinephrine. Nitroglycerine. Pavulon. The list went on and on, sometimes half a dozen in a night. Amy knew these drugs to be more commonly used in a cardiac unit. Charlie was working in Intensive Care. His orders emptied the drawers. Then, time and time again, Charlie ordered a restock from the pharmacy. His position in the hall with the Cerner meant he’d be the first to take the delivery. At the time, he was seen as being helpful. Now Amy wasn’t so sure. The refill orders were unusual, and showed up on his Pyxis. The Somerset Medical Center attorney, Fleming, had asked Charlie about that, as he’d asked about his frequent cancellations. But had anybody asked Cullen what he was doing with all that heart medication?

  Before bed, Amy picked up the phone to tell Tim. He and Danny were trying to trace a single gun; she thought the Pyxis was pointing to an entire arsenal. She still didn’t know what he was doing with it all.

  Amy went back to the bathroom, making a basin with her cupped hands and lifting the frigid well water to her face, but her heart palpitations were not irrational. She’d been looking for answers to who her friend really was. The answers had been there, on the pages of Charlie’s Pyxis data, and the distinct pattern of drug combinations he’d ordered.

  They were combinations which, from a physiological perspective, complemented each other, fitting toward a purpose the way individual notes contributed to a chord or an apparent disharmony of multiple boozes combined into a cocktail. It all made a terrible sense now. Amy needed to sleep, but she was afraid to dream.