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

by Charles Graeber

  But Prosecutor Forrest was worried that any more would look bad. It was 3 a.m., and the guy was grunting on the floor, practically frothing. They’d been pushing him for nine hours.1 Forrest didn’t think they could push him much further. They were done. Tim and Danny knew the guy would have a lawyer before morning.

  Tim drove home and hit the bed by 4 a.m. He hoped his internal clock would allow him to sleep in the next morning but nope, there was the sun, and he was up. Tim hated coming off a big case, dumping it into the institution. He wasn’t even the lead and he felt like that. Danny had to be worse. It was disorienting; it never felt right. His mind was still on emergency mode, trying to crack this guy. Instead, he was supposed to relax, recharge, let it go. He’d done his job. This was the weekend. Doo-dads to take care of around the house. Now there was time. Run down to the cabin, check the pipes. Errands. By early afternoon Tim found himself sitting in the mall parking lot, thrumming his finger on the steering wheel while his wife shopped at the craft store.

  What burned Tim was, they weren’t done with the guy. He would have gone, given another few hours. He had that look. Now, get a lawyer in there and the guy’s not opening his mouth again. It would drag on for a couple years and go to jury trial for one murder and one attempted—and that was if Somerset Medical Center didn’t have the juice to keep the whole thing under seal with a grand jury, which Tim figured they absolutely did.2

  Would the charge of killing Reverend Gall stick? Did they have enough to convict him, or would they have to cut a deal? Tim flashed back to his Duryea murderer, the guy convicted of one attempted, then walking after serving seven years. Tim could picture the guy. He was probably walking down the street, whistling a happy little tune at that very second. Maybe he was here at the mall right now, doing a little weekend Christmas shopping. Why not—everyone else in the world seemed to be here. After all, it was the friggin’ weekend.

  Tim thought about that, drumming the steering wheel. Thought about it some more. And then Tim thought, Maybe.

  Tim punched numbers on his phone and caught Assistant Prosecutor Tim Van Hise at home, who told him, sure, it was still legal, and he’d be willing to vouch. Cullen had signed his Miranda forms. He’d initialed that he understood his rights. He’d agreed to let them question him without the presence of an attorney. That was yesterday, but it still applied, absolutely.

  Cullen’s arrest had been made after hours on a Friday. He’d gone straight to the interview, and he hadn’t been processed at the county jail until early the next morning. It was the weekend. The judge was probably out Christmas shopping with his wife. Cullen hadn’t been arraigned yet. He hadn’t seen a judge. Tim called the clerk at the jailhouse. He had Charlie’s file still sitting there. It hadn’t been flagged by an attorney yet. Then Tim called Danny. It was the call Danny was waiting for.

  They could still take one more run at the guy. They weren’t finished. They just needed Amy back in Somerville one last time.

  62

  News of an arrest for patient murders at Somerset Medical Center was reported on Friday afternoon. The phone calls started less than a minute later, flooding the prosecutor’s office switchboard with over 175 inquiries and potential victims from tipsters and concerned family members. It was late afternoon before Tim and Danny could break free, leaving Detectives Brownlie and Magos to deal with the public while they walked across to the county jail.

  The sergeant let them past the screaming metal detector and the two-way mirrored wall through the series of buzzing electronic doors to the lockup. Tim and Danny found Cullen curled on his bed, staring at the wall.

  “Hey, there he is,” Tim said.

  Cullen turned. He gave them a flat look. Then he looked at the floor.

  “Treating you all right in here, Charlie?” Danny said.

  He glanced down at his new prison sneakers. “Yeah, it’s okay. These shoes don’t quite fit, but… you know. It’s cold…”

  “Yeah, well. We’ll see what we can do about that,” Danny said. “Meanwhile, tell you what. I don’t know if you—well, it’s like this. Your friend called again.”

  “Amy?”

  “Yeah,” Danny said. “Amy. She keeps calling.”

  “Won’t leave us alone,” Tim said.

  “She’s real worried,” Danny said. “Said she needed to talk to you. She’s upset.”

  The story Tim and Danny had concocted had Amy as a hysterical but loyal friend with influential friends in local government. “It doesn’t matter to us,” Danny said. “But now our boss is on our back. So, tell you what. Tim and I, we want to bring you back over to the interview room, continue our conversation.”

  “And you can talk to your little friend.”

  “Amy.”

  “Yeah, talk to Amy. You guys can talk, get her off our back. Afterward we talk, you and us. Good?”

  “Sure,” Charlie said. He had no problem with that.

  The sergeant opened Cullen’s gated door and escorted him to a metal table, where Danny handed him a Miranda Warning Form to read aloud. This was the second since his arrest, but Assistant Prosecutor Tim Van Hise had suggested the caution. Danny watched Charlie print “YES” and his initials by each line then sign the bottom, then they handed it to the sergeant to be time-stamped. Danny took the pen away again, in case Cullen got any ideas, and led him to the car for the ride back to the prosecutor’s office.

  Amy waited in a room1 in the prosecutor’s office, her eyes fixed on the flickering closed-circuit television. The screen showed the interview room, a plain cinder-block space with a table and plastic chairs made greenish and blurry by the video feed and reminding Amy of news footage from the war in Iraq. It was not a happy room to look at, at least not on the monitor, worse when Charlie appeared. He was stooped and affectless. His arms and legs were bound in chains. He shuffled forward in beige prison scrubs and shoes without laces. Amy felt nauseous. She had done that to Charlie. The guilt overwhelmed her, and she burst into tears. What had she done?

  There were other detectives in the room with her: Captain Nick Magos, the lawyer from the prosecutor’s office, Tim and Danny, maybe others coming and going—by now she knew the guys by sight, at least. They certainly seemed to know her. She was Amy, the confidential informant. They told Amy she was great, a natural, pumping her up. Words. She heard other words, like death penalty, life in prison. On the screen, Amy watched her friend, the one they wanted to kill, the meek little man shivering on his plastic chair in the war bunker. The killer the men talked about wasn’t here now. She saw only a little boy, frightened and alone. She had sent this boy to prison and yet there he was, waiting for her, honestly believing that she had come as his friend. And in that moment, he was right. She was his friend, somehow, still. Charlie’s eyes darted around the room, then found the camera mounted on the wall, and held it. Amy felt herself blush with terrific shame. He couldn’t see her, she knew that. But it didn’t change the way she felt.

  The detectives started in on Charlie from the top, tag-teaming like the night before.

  “Look, you know, Charlie, this is going to come out that you were getting off, sexually, on killing these people. Or we can go with the mercy-killing thing. It’s up to you.”

  Then Danny came in, with his own version.

  Then it was Tim. Then Danny.

  Then it was Amy’s turn.

  The detectives led Amy along a maze of corridors and office doors, the men talking, Amy not hearing anything but her own heart. The doors all looked the same. She felt like she was in hell, or on a game show. Finally they stopped at one, opened the door, and left Amy in a room with a couch. She sat down on one end, then the other, deciding eventually on a perch farthest from the door. And then finally she allowed herself to look around. It was an especially plain room with unadorned walls. The only other furnishings besides the hard couch and a few scratchy woolen pillows were a coffee table, a cabinet, and a wall-mounted camera. She assumed the camera was on. The coffee table had a
tape recorder taped to its underside, the kind she remembered from fifth grade. The cabinet was full of dolls.

  Amy looked closer. The dolls were all anatomically correct. It was the room used to investigate sex crimes against children. She sat on the couch, staring at the little Muppet-type penises and vaginas. She hadn’t told anyone from the prosecutor’s office that she’d been sexually abused; she hadn’t shared that with anyone, but still she wondered if there was something about her that telegraphed this fact, if they’d put her here on purpose. Hell or a game show. Amy couldn’t help but think how different it would have been if a lady cop had brought her to a room like this when she was seven, how her life could have gone and the nightmares she would never have had to know. But nobody had protected her then, and when she had tried to protect herself, her family didn’t believe her. They had told her the man she accused wasn’t like that. He was so nice. He was a good uncle. But Amy knew that inside the good uncle was a monster. He was there during birthdays and Thanksgivings and Christmases. He was always there whether anyone saw him or not. This was the truth of Amy’s life. And it was also the truth of Charlie’s.

  Charlie entered the room, unshackled. Amy gave him a sympathetic smile. It didn’t feel false. She wasn’t nervous any more. Charlie sat next to her on the couch. He was still small, still meek, like a frail stick figure in beige PJs and blue canvas shoes. He still looked like the scared little boy. The short-sleeved jail shirt showed his bare arms. It was the first time Amy had ever seen them. They were blue-pale and thin. Her eyes ran to a thick scar along his biceps.

  He’d done that himself, he said. A botched suicide attempt. Charlie told her how, in basic training, they’d said, “If you’re going to kill yourself, ladies, do it right!” and showed them. The standard method—slicing across the wrist, as if slitting the arm’s throat—resulted only in pain. But cut down the arm, longways, you bleed right out. “This way for show, this way to go,” they said. It was just tough-guy talk, the sort drill sergeants yell, but Charlie remembered, and one afternoon he put down his mop, walked to the bathroom, and drew a line down his arm with a razor blade. The drill sergeants were right. And when he saw the blood, how thick it came and saw, My God, his own muscle down there, the white cord of tendon, he started screaming.

  “So, basically, I’m a screw-up in everything,” Charlie said. Twenty suicide attempts, and here he was, still breathing. They laughed about that. But that suicide had taught him something. In crisis, whenever he felt cornered or impotent, Charlie’s instinct had always been to subvert those feelings with the threat of death. But in truth, he wasn’t particularly interested in being dead, not personally. His nursing career resolved the paradox. Access to the vulnerable allowed him to manifest death without dying. He’d learned to kill himself by proxy.

  You couldn’t tell Charlie what to do. He would never be forced, the child with his arms pinned, helpless to the older boy on top, no. The detectives couldn’t make him do anything like that. But he could do something. Amy didn’t demand the truth, but Charlie could give it.

  Amy looked into his eyes and knew where he needed to go. Charlie didn’t need to be a saint, lord knows he wasn’t one. He knew right from wrong, knew what he’d done was bad, in that it was illegal. No, he wasn’t a saint. But he needed to be a hero. He could be that, for her.

  Once he started, it was easy. It wasn’t a confession so much as a story about himself, and one that he liked to hear. He sat in the interrogation room chair with his feet tucked up and Amy’s soft cardigan caped across his shoulders. Charlie had the floor. The detectives wanted him to talk about Reverend Gall. He told them about Gall. Then he kept telling. His was a long road backward, and he walked through it carefully.

  Charlie hadn’t kept a written list of what he’d done, he didn’t keep mementos of his crimes, and he had never told anyone his full story aloud. But all along, he’d been telling himself, reliving the edited memories like a song stuck in his head. He started talking at 6:15 on Sunday night, stopping only for food and coffee and toilet breaks. He spoke for seven hours in a hushed, level tone, patiently pausing midsentence whenever Tim flipped a tape, then picking up again at exactly that point, expounding on the technical complexities of the profession, the vagaries of a lifetime of expertise, and vignettes of depressions and suicides, loves hilariously squandered, situations that did not suit. Each was a data point in service of the agreed-upon arc of a misunderstood wanderer wielding a benevolent, if criminal, compulsion. The patients “passed” or “expired” or sometimes “died”; he “intervened” or was “compelled to intervene”—but Charles did not “kill,” and there was no “murder.” It was a gentle story, a narrative long rehearsed but never performed; for the sick, for their families, death was a grace that not only God could give.

  They only needed one; Charlie had given them forty when the tape ran out. It was late, and the detectives were done for the night. And at 1:31 a.m. Monday morning Charlie left it at that, leaving the detectives to their paperwork, and so much so unsaid.

  Post Script

  The media quickly dubbed Charlie “the Angel of Death.” We will never know exactly how many patients Charlie truly murdered. The source for most of the evidence in the cases against Charles Cullen came, by necessity, from Cullen himself. Cullen initially confessed to killing perhaps forty people. In his recounting, Cullen missed several names, skipped entire years and hospitals, and wouldn’t hazard guesses regarding those he wasn’t absolutely certain he had killed. At Lehigh Valley Hospital, for example, Cullen recalled that he was responsible for four or five victims; so far, only two have been positively identified. And though Cullen initially said that he hadn’t overdosed anyone at Hunterdon Medical Center, five victims would ultimately be discovered there. Experts with an intimate knowledge of the case say that the real number of his total victims is likely closer to four hundred. Charlie has heard this number, and while he does not like it, he does not deny it, either. Nor does he acknowledge that this number, if accurate, gives him the ignominious distinction as the most prolific serial killer in American history.

  The problem in accounting for Cullen’s exact death toll was evidence. By the time the SCPO was alerted, many of the medical records were missing or incomplete, and most of the dead were already dust, making autopsies impractical. Sorting Cullen’s private death toll from the general cadence of hospital mortality would prove extremely difficult. At the first hospitals Cullen worked, where the records have been destroyed, a proper accounting would prove nearly impossible.

  His formal confession contained only one name from his five years at his first job in the Burn Service at Saint Barnabas Medical Center—that of Judge John Yengo, on November 6, 1988. But Cullen had earlier recounted that his first murder was that of a young Saint Barnabas AIDS patient, in 1987. This patient has never been identified. Nor have any others at Saint Barnabas. The only surviving records from that time were the incomplete file the detectives had retrieved, and some handwritten pages later discovered in a desk drawer in storage which detailed Barry and Arnold’s investigation into the spiked bags of insulin and the rash of insulin overdoses on the CCU. Later, Cullen admitted to homicide detectives that he had been both targeting patients and spiking insulin bags at random, sometimes three or four times a week at Saint Barnabas. Without medical charts and autopsies, these numbers could not be verified. As of this writing, he has been convicted of only one murder or attempted murder from his five years at this hospital. He worked at eight others, for eleven more years. It is perhaps useful to contrast this number with the list of victims specifically identified when detectives had access to complete and computerized medical charts and drug data, as they did at Somerset Medical Center, where sixteen murders were ultimately confirmed from just the last six months of Cullen’s career.

  Led by the tireless efforts of Detective Danny Baldwin, Tim Braun and the Somerset County detectives cross-referenced some 175 tips with Cullen’s work schedule, assignment sheets,
Pyxis records, and Cerner transactions. The initial result was a list of twenty-six high-probability victims from Charlie Cullen’s year at Somerset Medical Center alone. Charlie said a few names “jumped out at him.” For the rest, he said, he’d need to review the charts.

  In April 2004, Charles Cullen pleaded guilty in New Jersey court to thirteen murders and two attempted murders, crimes that legally qualified him for the death penalty. Charlie had initially claimed that he in fact wanted to be put to death. He told this to Amy, as well as to the Somerset County detectives during his taped confession. But he never told it to his court-appointed lawyer, senior public defender Johnnie Mask. But then, even Charles Cullen’s suicide “attempts” had never truly been about dying. Charles Cullen wanted to live. He and Mask cut a deal with New Jersey prosecutors, who agreed to take the death penalty off the table in exchange for his cooperation. Danny Baldwin and the SCPO team would spend the next three years investigating.

  Months turned to years at the Somerset County Jail in Somerville, and Charles Cullen’s life assumed a regularity he had rarely known as a free man. He had his cell, his spy novels, time to exercise or shower or meet with the Catholic deacon or the head chaplain, with whom he was studying the lives of the saints. The guards would escort him across the lawn to the prosecutor’s office, to sit with Danny or Tim and pull through the arrhythmic EKGs, the final flatlines, and the bloodwork of thousands of patients. The spotlight was always on him. Nothing could have suited him better.

  There were new charts nearly every week, boxes of them, covering sixteen years of death at nine hospitals. The detectives and lawyers ordered donuts, sandwiches, and chips—little perks for dealing with the paperwork of death—and as winter became spring and winter again, they packed pounds beneath their chinos. But Charlie just squirreled through the case files with a cup of black coffee, growing thinner and thinner, getting it done; eventually, when the investigations were closed and the shouting was over, he could take his life sentences into his cell and disappear completely.