October 22, 2013

Joy Jacobson is the CHMP’s poet-in-residence. Follow her on Twitter: @joyjaco.

good nurseI have an odd confession. When I was the managing editor of the American Journal of Nursing for most of the 2000s, I kept a log of criminal nurses. I’m not entirely sure why; perhaps the nursing profession’s perennial lead in Gallup’s “honesty and ethics” poll made me want to explore its underbelly. Through periodic web searches I found more than a few “angels of death,” nurses who purported to end their patients’ suffering by murdering them with high doses of morphine or other drugs. I found rapists, thieves, addicts, pedophiles. But nothing ever matched the terrifying 16-year spree of critical care nurse and serial killer Charles Cullen.

Journalist Charles Graeber has written an engrossing book about Cullen, The Good Nurse: A True Story of Medicine, Madness and Murder. Graeber will be at Roosevelt House in New York (47-49 E 65th St., between Park and Madison Avenues) this Thursday at 6 PM, talking with health care journalist Charles Ornstein and nurse attorney Edie Brous about Cullen’s pattern of killing in various New Jersey and Pennsylvania hospitals. Hospitals, Bad Practitioners, and Accountability: Lessons from the Case of Serial Killer Charles Cullen is free and open to the public. RSVP at centerhealthmediapolicy@gmail.com.

I found Graeber’s narrative style to be deeply affecting. Here he is describing one of Cullen’s earliest victims, the Rev. Florian Gall:

Charlie would study the man at night, his bald head glowing in the light of the machines, his clerical vestments exchanged for a disposable frock. He looked nothing like the priests of Charlie’s youth, nothing like God’s man on earth—he looked sick, and very human. That was his prognosis. Charlie knew the charts, he’d pulled the little computer cart to the corner of the Cardiac Care Unit to pore through the drama of numbers.

Rev. Florian Gall coded at approximately 9:32 AM the morning of June 28. He went unexpectedly into cardiac arrest, and heroic measures were undertaken. They were unsuccessful. His time of death was noted in his chart: 10:10 AM. Gall’s bloodwork showed that his digoxin levels were off the charts.

The Somerset Medical Center administration had a problem. It was not a natural death. And Gall wasn’t the first. They called him “Patient 4.”

Cullen himself knew that the hospitals that employed him permitted his long career as a killer. In a 60 Minutes segment (online in two parts: here and here) on Graeber’s book and the investigation that ended in Cullen’s confession in 2003, Steve Kroft asked Cullen: How could he have been passed off from one hospital to the next, receiving good or neutral references? Why did no one go to the police when it became obvious that Cullen was implicated in patient deaths? Cullen blinked as though blinded by the sun: “I think because it’s a matter of worrying about lawsuits. If they pointed out here was a problem they would be liable for millions of dollars.”

Having spent seven years investigating the case, and interviewing Cullen a dozen times, Graeber chose to tell the story as a story, one in which on every page I came face to face with what was at stake for so many. (Cullen admitted to having murdered as many as 40 patients, but Graeber estimates the number may be 10 times that.) Graeber painstakingly reveals his sources but only in his endnotes, thus allowing the reader to feel the impact of Cullen’s choices, patient after patient, as well as the legalistic horrors that allowed him to continue to practice and the heroic efforts of Cullen’s fellow nurse, Amy Loughren, who finally urged him to confess. As one reviewer put it, “Graeber has accomplished something remarkable: he’s allowed himself the freedom to construct the main narrative for maximum impact while never jeopardizing our trust.”

I hope you’ll participate in what should be a fascinating conversation.