In 'The Good Nurse,' Charles Graeber chronicles how a serial killer may have slain up to 400 patients

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Charles Graeber's "The Good Nurse: A True Story of Medicine, Madness and Murder" is a very scary book. It will reach out and grab you and not let you go. You will forgo food, talking, work, anything just to get to the climactic moment of this true crime story.

Part One introduces the book's anti-protagonist. Charles Cullen, mild-mannered registered nurse, is helpful and friendly. He always starts work early and leaves late. People who get to know him find he has a self-deprecating sense of humor and a sense of perspective on his depression and alcoholism.

His first wife thought she knew him. He was so enthusiastic about their courtship, their marriage in 1987 in Livingston, N.J., their new house in Phillipsburg near the Eastern Pennsylvania border, and his job at the burn unit of St. Barnabas Critical Care Unit in Livingston. He had just gotten his New Jersey registered nurse license at age 27.

Then suddenly, Cullen didn't seem to care about his wife's little dog any more. And he spent all his free time in the boiler room, drinking from a stash he kept locked up. He didn't seem to see or do anything when he drank. Cullen just stared at the flame in the boiler. Sometimes, his eyes seemed to look in two different directions.


By Charles Graeber.
Twelve ($26.99).

They had their first daughter. After that, he paid even less attention to his wife. She bought a puppy to keep her first dog company. But the puppy disappeared. Cullen was vague about how that happened. It must have gotten loose while he was on a walk while the baby was sleeping, he said. He went for a walk, leaving the baby alone and the door open? she asked, appalled. Don't worry, he told her. I know the baby won't wake up. He seemed a bit too certain of that. Then a neighborhood dog that her husband found annoying turned up dead, poisoned, in an alley.

And Cullen's place of employment was investigating him. For what, his wife wanted to know. They were making a scapegoat of him, he explained. There had been some incidents at the hospital. Someone was spiking IV bags with insulin. Very dangerous.

The hospital stopped calling him for shift work, and Cullen quickly got another nursing position. He and his wife had another baby. But now Cullen's drinking was really bad. And Charlie began to fake suicide attempts to get his wife's attention at home. His wife filed for divorce, and Cullen made a suicide attempt that landed him in the hospital.

Welcome to Cullen's life. The pattern has been set. If he is accused of being the bad guy, he attempts suicide so that he looks like the victim. He finds new nursing jobs in New Jersey and Eastern Pennsylvania around Bethlehem. At at each hospital, large quantities of dangerous drugs disappear. And patients begin dying at abnormal rates.

Nurses notice disturbing patterns and report them. But it's very tricky to prove in court that hospital deaths are anything more than natural. After all, people in intensive care units and emergency rooms have life-threatening conditions. And if they happen to have severe reactions to medication that wasn't prescribed to them or even from Tylenol they weren't supposed to have, well ... accidents happen.

But the nurses and administrators in these cases knew Cullen was killing people. The administrators just didn't want that information reaching the public.

So each hospital let Cullen go, often with neutral references. An administrator might call a few nearby hospitals and warn them not to hire a certain Charles Cullen. Or, if he had been hired, warn them that their new hire, without naming names, should not be around any patients.

Of course, one can't call every hospital in the state. Or in nearby states. Inevitably, Cullen found new work. Part Two of the book is about the investigation that brought Cullen down in 2003, leading to his eventually pleading guilty in 2006 to 13 murders and two attempted murders.

The real number may be closer to 400. If true, that number makes Cullen the most prolific serial killer in U.S. history. If any criticism can be leveled at this book, it is that the story bogs down once Cullen is in jail in New Jersey (where he's serving 11 consecutive life sentences).

Cullen made news there by donating a kidney to the brother of an ex-girlfriend. This postscript could have been disposed of in a few sentences, not pages.

Even so, Mr. Graeber's book builds inexorably toward a horrible, climactic moment in a restaurant, when the mask is stripped away. Sometimes evil isn't a thing; it's a void.


Laura Malt Schneiderman is a Web content producer for or 412-263-1923.


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