The Good Nurse: A True Story of Medicine, Madness, and Murder (41 page)

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 screwup 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.

O
nce 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

T
he 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.

M
onths 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.

Then, in August 2005, an envelope arrived at the Somerville jail. By now Cullen was inured to the interview requests and the hate mail, even the odd “fan letter,” but this was something new: a thin clipping from a Long Island community newspaper with a few paragraphs about a man named Ernie Peckham and a margin note jotted in girlish cursive: “Can you help?”

Cullen knew Peckham—a guy about Charlie’s age, with four kids and a wife at home and a job shaping metal for window casings and revolving doors in Farmingdale. He was the brother of Catherine Westerfer—Charlie’s estranged ex-girlfriend and the mother of his youngest child, whom he had never seen and probably never would. Maybe he and Ernie had said
hey
at a wedding a few years ago, Charlie couldn’t recall, but they weren’t friends, they weren’t even acquaintances, they certainly weren’t close enough to swap organs. But according to the article, that was what Ernie needed.

Doctors don’t know exactly how or when, but at some point in 2003, Ernie contracted strep. Probably it was just a little scratch that got infected, the sort of thing that either swells up and goes away or takes you out for a week with a sore throat and a dose of antibiotics. But Ernie didn’t notice the infection, and it spread. His immune system attacked the burgeoning bacteria, creating complex protein knots that caught in the microscopic filters in both his kidneys. Normally, these filters would have been removing toxins from Ernie’s blood and excreting them with his urine; now, they were like a sink clogged with hair. Ernie’s body began to bloat with its own poisons,
swelling his hands and face and turning his urine the color of cocoa. By the time he saw a doctor, his kidneys were dead. Untreated, he’d be next.

Charlie had never worked as a nephrological nurse, but he knew that once a kidney’s filters are bunged up, you can’t really fix them. Dialysis is the most common option, a method of removing fluid and filtering blood through a machine. Ernie regarded his three weekly two-hour dialyses at Stony Brook Hospital “another full time job,” and the hassle hadn’t stopped his deterioration. His access veins kept clotting off. The access port that surgeons had sewn into the major vein in his neck was like a wound that never closed, and it opened him to dangerous new infections. Ernie had been forced to give up his scoutmaster post and had scaled back his time at the local VFW. But if he really wanted to get his life back, dialysis wasn’t going to do it. What he really needed was a new kidney.

At the time, there were around sixty thousand people waiting for a kidney in this country. Most would come from cadavers (donation rates are highest in early spring, when new motorcyclists take to roads still edged with winter sand). But a cadaver kidney has a lessened life expectancy of six years compared to that of a live donor; the waiting list for such a random cadaver donor was between five and seven years long—a wait that, as Ernie’s health deteriorated, was beginning to look like a death sentence.

The best way to match kidney with recipient is through a blood relative, but nobody in Ernie’s family was medically eligible to donate one of theirs. Now his only chance was to find the perfect stranger. Unfortunately, the odds of one random individual being a perfect tissue-typed match for another random individual—of a donation being personal—are staggeringly small. Ernie Peckham had a better chance of being struck by lightning. Ernie’s mother, Pat Peckham, had already mortgaged her house to help with her son’s medical bills, and she contacted the local paper to run a public-interest item with Ernie’s blood type and the hospital’s donation hotline number. She was hoping for a miracle donor. But no miracle donor called. Pat was running out of options for saving her son; she was willing to try anything or anyone who might help. And what would it take except a stamp? So she clipped the article out of the paper, stuck it in an envelope addressed to the Somerville prison, and waited for her miracle. The thing about miracles: you couldn’t really predict what form they might take, or what wings would bear them. It might be anyone, even the serial killer who had knocked up her daughter.