The Good Nurse: A True Story of Medicine, Madness, and Murder (45 page)

I’d still be grunting or grammarless if not for my mom, Diann Waterbury Graeber, a former English teacher who knows doctors as only a daughter and wife can and loves writers as only a mother could or should. A book about murder by chemistry only seemed palatable because of my father, Dr. Charles W. Graeber, the kindest and hardest working man I know; following him on rounds as a kid has left me with a sense memory of the hospital night shift inextricable from childhood itself. Both he and my grandfather Dr. Carl Waterbury D.O. (whose first date with my grandmother Patsy ended up as an emergency house call and home birth in Des Moines’ southeast “bottoms”) inspired a reverence for the art of medicine which, I hope, informs the grim details.

Somehow I was lucky enough to have the tireless advocacy of the Golomb Agency’s Susan Golomb, who, from the moment I first sweated through her office chair one hot August afternoon, was a champion for my work as I could not be. And particular respect and gratitude are owed to the Twelve/Hachette Book Group team: the efforts of editoral assistant Libby Burton, the tolerance of Grand Central Publishing senior managing editor Bob Castillo, the patient wisdom of veteran associate publisher Brian McLendon, and most especially my fearless publisher and editor, Cary
Goldstein. Cary fought for this book and won, and I owe him a debt, as well as a fresh red pencil. He’s a terrific editor and a true mensch. Publishing needs him.

Most personally, I cannot begin to count the saving insights and raw kindnesses of my beloved Gabrielle Allen, who somehow tolerated this Charlie writing about that Charlie, which wasn’t always fun, and whose partnership makes everything seem possible.

ABOUT THE AUTHOR

C
HARLES
G
RAEBER
spent many childhood hours in hospitals, waiting in nursing stations and visiting patients with his physician father. He deferred Tulane Medical School to pursue a story in Cambodia and never returned. His writing has been recognized by awards from the Overseas Press Club of America, the New York Press Club, and the American Academy of Poets, and anthologies including
The Best American Crime Reporting, The Best American Science Writing, The Best Business Stories of the Year
, and
The Best of National Geographic Adventure
. He is a contributor to
Wired, GQ
, the
New Yorker, New York, Outside, Bloomberg Businessweek
, the
New York Times
, and others. A native Iowan, he now lives in Nantucket and Williamsburg, Brooklyn.

ABOUT TWELVE

TWELVE was established in August 2005 with the objective of publishing no more than twelve books each year. We strive to publish the singular book, by authors who have a unique perspective and compelling authority. Works that explain our culture; that illuminate, inspire, provoke, and entertain. We seek to establish communities of conversation surrounding our books. Talented authors deserve attention not only from publishers, but from readers as well. To sell the book is only the beginning of our mission. To build avid audiences of readers who are enriched by these works—that is our ultimate purpose.

For more information about forthcoming TWELVE books, please go to
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.

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NOTES

1
Born February 22, 1960.

2
After his father died seven months later, the eight Cullen children survived on church charity, the sewing his ailing mother took in, and the disability checks his paternal aunt received for her deformed leg.

3
On Kling Street.

4
He was twenty-four years old.

5
In an eighty-seven-person class.

6
Charlie didn’t like the risk of humiliation that running for election, or anything else, seemed to promise, but his friend insisted.

7
Information about the relationship between Adrianne Baum and Cullen was gathered through interviews with both parties; Ms. Baum has never before allowed herself to be interviewed. Names have been changed at Ms. Baum’s request.

8
Adrianne felt that she really knew her beau, but she knew him alone; other than his sister Maureen, who had worked at Roy Rogers for a time, Adrianne had met none of Cullen’s family or friends. When she asked to see where Charlie had grown up or to meet the brothers, her boyfriend went mumbly and defensive. She remembers that Charlie’s brother James died soon afterward, right in Charlie’s old bedroom—an apparent drug overdose, possibly a suicide. The eldest Cullen brother, Edward—the one called Butchy—called from a pay phone drunk and overwhelmed with the news; Charlie drove him back to Adrianne’s apartment to let him sleep it off on the couch. That was their first meeting. The only other time Adrianne saw Butchy was at her wedding.

9
He was twenty-six years old.

1
As Charlie started his career, he was aware of the shocking headlines regarding another killer just finishing his. On April 6, 1987, a depressed, suicidal, Air Force dropout turned nurse named Donald Harvey was arrested for murders committed while he worked as a nurse in Ohio and Kentucky. Harvey had been given the nickname “Angel of Death” by his coworkers, for his constant proximity to coding patients. Harvey would be convicted of thirty-four murders.

2
These are often referred to as “granny burns” because they are most commonly seen in the elderly, when loose clothing catches fire over an open flame such as a stovetop.

3
They are called
escharotomies
, from the Latin for “scar.”

4
The practices described in this chapter date to the early ’90s. Modern burn wards are far quieter, and pain and anxiety are carefully titrated with new classes of drugs.

5
While other dates have been offered, this is the most likely; Saint Barnabas Medical Center records from 1987 were lost or destroyed sometime prior to the Somerset County Prosecutor’s Office investigation. As it happens, this is also the date, in 1992, when Charles Cullen murdered Judge John Yengo. While Cullen acknowledged at least one other victim prior to Yengo, his was the first murder victim to whom he confessed by name to the police.

6
A Levite from Cyprus who facilitated the church’s destiny, it was Barnabas, sent to the booming Christian population in Antioch, who recognized the importance of having a Christian beachhead in Greece and pulled the apostle Paul out of retirement.

7
As a newly minted apostle himself, Barnabas preached to the pagans in Lycadonia. The Lycadonians assumed that he was not a preacher, but God himself. Barnabas was talking Jesus; they called him Jupiter. Was the Son of Encouragement discouraged?

Sources: Little Pictorial Lives of the Saints, a compilation based on Butler’s Lives of the Saints, and other sources by John Gilmary Shea (Benziger Brothers: New York, 1894); Les Petits Bollandistes: Vies des Saints, by Msgr. Paul Guérin (Bloud et Barral: Paris, 1882), Vol. 6.

8
He was stoned to death by recalcitrant Jews in Salamis on the island of Cyprus.

1
The children’s names have been changed at the request of Adrianne Baum.

1
The details of these incidents and the investigation that followed come from police investigation reports, witness statements, and court documents, in addition to interviews with Charles Cullen and Thomas Arnold.

2
Heparin is an anticoagulant, useful for thinning the blood to prevent the clots that can precipitate heart attacks and strokes, but antithetical to stopping bleeding after surgery.

3
By Endocrine and Radioisotope Laboratories of Livingston, New Jersey, and Abbott Hospital Products Division of Abbott Park, Illinois.

4
Arnold told investigators that the units on which their Charles Cullen investigation focused was the old Cardiac Care unit on the sixth floor and the 5700 unit, both cardiac units. Arnold and Barry were so focused on Cullen as the suspect that they concentrated their analysis of death rates only upon the units in which he worked; Arnold stated that he had not looked into the Burn Intensive Care Unit (BICU) due to Cullen not having worked in that unit at the time when their investigation was being conducted.

5
Initially, Cullen and two other female nurses were under suspicion. One of the nurses was cleared, and the other was found to have been stealing morphine for her own personal use.

6
This was the first of two interviews Arnold and Barry would hold with Cullen regarding their investigation.

7
The investigation included patient chart reviews, work schedules, Pyxis medication dispensing cabinets, video surveillance of medical rooms, interviews, evidence (IV bags), and pathological analyses.

8
Police investigation records. This was Charles Cullen’s recollection, as well as that of his ex-wife, Adrianne, in a witness statement to police, and expanded upon during a 2010 interview with the author. Cullen being the primary focus of the investigation was the direct statement to the Somerset County Prosecutor’s Office by Betty Gillian (the woman who, as administrative director of critical care, had fired Cullen); Gillian’s testimony was given November 14, 2003, when she was serving as supervisor and vice president at the Saint Barnabas Hospital corporate offices. Thomas Arnold independently confirmed that Charles Cullen was the primary focus of their investigation.

In a response to uniform interrogatories arising from civil litigation in the wake of Cullen’s sentencing, Saint Barnabas Medical Center counsel Sills Cummis Epstein & Gross P.C. rejected the claim. “Saint Barnabas did not perform or cause to be performed any internal investigation as a result of unexplained laboratory results regarding medications in patients or unexplained patient deaths while Charles Cullen was an employee of Saint Barnabas, Livingston Health Care Services, or Medical Center Health Care, Inc. In February and October of 1991, internal investigations were conducted at Saint Barnabas regarding unexplained low blood sugar levels in several patients… In this regard, Saint Barnabas notes that it has only been able to retrieve a portion of the documents related to these investigations; the rest are believed to have been destroyed years ago during the course of an office move.” The brief goes on to state, “The 1991 internal investigations regarding unexplained low blood sugar levels in several patients did not focus on Charles Cullen.” This document was signed by Nancy Holecek, senior vice president of patient care services at the Saint Barnabas Health Care System, speaking on Saint Barnabas’s behalf. Ms. Holecek was a former Telemetry unit director, and also involved with Barry, Arnold, and Gillian in the investigation.

9
Then Telemetry supervisor Nancy Holecek would later compare the process to finding a needle in a haystack.

1
Charles Cullen, interviews by the author.

2
Cullen was technically employed by Medical Center Health Care Services, formerly Livingston Health Services, a wholly owned for-profit subsidiary of the Saint Barnabas Health Care Corporation, which supplied staffing to the units. Depositions of Medical Center Health Care Services staffers explain that between January 6 and January 10, 1992, Cullen became a “do not book,” as the terms
terminated
and
fired
were as policy not used. The cause given for termination was poor documentation and a “decreasingly poor attitude.” For example, Cullen was found on June 20, 1990, to have canceled a physician’s continuous ventilation order for one burn patient and, on the morning of June 21, canceled another vent order for another patient. Among his documented issues are several medication errors, including a March 14, 1991, occurrence in which an incoming nurse found Cullen had failed to give his patient the medicine the doctor had prescribed, and instead hung an IV marked only with a red label without writing on it. His coworkers expressed a “deep concern re: Charles’s attitude toward making this dual medication error” and felt he was “not at all concerned about the error or the welfare of the patient.” Among several other incidents potentially affecting patient safety was a July 26 occurrence in which Cullen had written on a patient’s chart a doctor’s order for four units of insulin; in fact, no insulin was to be given that patient.