Serial Killer Nurse, Spiked IV Terrorize Hospitals: Books

Charlie Cullen was a good nurse for the 16 years he worked at various New Jersey and Pennsylvania hospitals -- if you overlook the countless patients he murdered.

His managers largely overlooked them, and as Charles Graeber recounts in “The Good Nurse,” no final toll is possible. The estimates are awful to contemplate.

Almost 10 years ago, Cullen confessed to “killing perhaps 40 people,” Graeber writes. The nurse terminated 16 patients in just the final six months of his working life. Yet experts believe the total is “likely closer to four hundred.” Cullen’s cooperation spared him the death penalty, and he’s serving life without parole in New Jersey state prison in Trenton.

Graeber, who has written for Bloomberg Businessweek, the New Yorker and others, invested six years of research into Cullen’s medical madness. From interviews with the killer and those around him, the author details how he did it and how he got away with it for so long.

Cullen did come under managers’ suspicion and was questioned by police, but he passed the human and polygraph tests. He was abetted by the hospitals’ fear of legal fallout and the blow to the bottom line (they were all sued in the end).

At one institution, the same person who “threatened to terminate Cullen for his multiple medication and patient-care issues” recommended him for employment at his next hospital job, and a reference form described him as “an excellent nurse” who “gave good care.”

Fatal Medications

Cullen’s modus operandi varied. He spiked IV bags with hypodermics full of unprescribed and usually fatal medications. He injected patients directly with the wrong stuff or withheld prescribed doses. He foiled security measures meant to restrict nurses’ access to medication.

He played a kind of lottery, in which he dosed IV bags without knowing which patient would get them, then monitored those on his watch. He also made cocktails of drugs to observe the effects leading to death.

His victims tended to be in ICU or cardiac care, so when they “coded,” when their breathing or heart stopped, it wasn’t always surprising. A sad, shy man with “a dead look in his eyes” to some, or an “emotional disconnect,” Cullen was clever and grimly efficient.

After spending more than half the book in his drearily malevolent company, I was relieved when the narrative shifted to a taut police procedural with a genuine heroine as the police closed in on Cullen.

Confidential Informant

Two former Newark, New Jersey, detectives transplanted to Somerset, the state’s richest county, were drawn into the case in October 2003 by a report of “unexplained incidents” at Somerset Medical Center, the area’s biggest employer.

Frustrated in their inquiries by the center’s lawyers and staff, and outmaneuvered by Cullen when they tried to pressure him, the cops finally scored a breakthrough when a nurse friendly with Cullen agreed to become their confidential informant. The killer confessed in December that year.

Graeber’s writing becomes markedly brighter as the book shifts from case history to cop thriller. It’s here, though, that I noticed more the unfortunate effects of converting interview material into a character’s thoughts, which Graeber freely does throughout the book.

An extreme instance: The informant, who wore a wire for a pivotal conversation with the killer, afterward confronted “a confusion of unprocessed emotions.” One is pride in her bravery, until “she realized (yuck!) she was stoking her ego because of her proximity to murder and infamy.” That “yuck” is yuck itself.

Seeking Reasons

Graeber wisely doesn’t pontificate on why Cullen murdered so many. No simple answer is possible. Cullen himself has suggested that at times he was relieving the pain of others.

The killer’s mother died in a car accident when he was in high school but her body had disappeared by the time he reached the hospital. After that he always associated hospitals with deceit, according to Graeber.

There’s also a suggestion that Cullen was sexually abused as a child. Add it to a list that includes depression, suicide, bullying, botched romance and broken marriage to form a man feeling years of victimization and armed with the limitless power of a competent caretaker.

“The Good Nurse: A True Story of Medicine, Madness and Murder” is published by Twelve (307 pages, $26.99). To buy this book in North America, click here.

(Jeffrey Burke is an editor with Muse, the arts and leisure section of Bloomberg News. The opinions expressed are his own.)

Muse highlights include Jeremy Gerard on theater and Farah Nayeri on Cannes.

Before it's here, it's on the Bloomberg Terminal.