Book Review: The Good Nurse by Charles Graeber

Let me begin by saying that this book hit home for me. As a born and raised Jerseyian, I felt compelled to read it. I wanted to learn about this New Jersey native Charles Cullen; his biography and the causes of his behavior. I’m familiar with the town where Cullen grew up, the hospitals that employed him, and the prison at which he is serving his life sentence. My brother met him, you could say when he worked at the New Jersey State Prison (NJSP), formerly known as Trenton State Prison, where Cullen is incarcerated.

I appreciate the layout of the story. It walks you through Cullen’s life: his upbringing, military service, marriage and kids, employment as a registered nurse and the crimes he committed, and finally his arrest and sentencing. I’m going to follow a similar pattern in this blog, providing an outline of events starting with his childhood and diving into his adult life and crimes. In the end, I’ll share my thoughts on Cullen and the reason for his behavior, and the book itself.

*Alert: This blog contains spoilers!

Overview

Upbringing

Cullen’s childhood was an unhappy one.

He was born in West Orange, New Jersey in 1960. He was the youngest of eight children in a working-class Catholic family. His father, a bus driver, was 56 when Cullen was born. He passed away when Cullen was only seven months old.

During his childhood, Cullen was constantly bullied by his sister’s boyfriends and his classmates. Many saw him as a misfit; strange and socially inept.

The first of at least 20 suicide attempts began at the age of 9. Cullen drank a mixture of chemicals from a home chemistry set.

When he was a senior in high school, his mother died in a car accident. Her death devastated him. He was also angry with the hospital for not immediately informing him of her passing and they would not return her body. They cremated it.

Shaken by his mother’s death, Cullen dropped out of high school and enlisted in the U.S. Navy. Despite his rise in rank, he didn’t fit in and showed signs of mental instability. After a suicide attempt, the Navy sent him to a naval psychiatric hospital. Cullen ultimately received a medical discharge.

In 1984, the same year he left the Navy, Cullen began nursing school at Mountainside School of Nursing. He graduated in 1987 and got a job at St. Barnabas Medical Center in Livingston, New Jersey. The first of many hospitals that employed him…

Marriage and Kids

The same year Cullen started his nursing career, he married his girlfriend, computer programmer Adrienne Taub. The couple had two daughters.

Not long into their marriage, Adrienne noticed Cullen didn’t play the part of father or husband. He didn’t help with the children, lacked emotions, and would often make his way into the basement to drink alone. Overtime, Cullen’s odd behavior grew and Adrianne became disturbed and concerned. Cullen physically abused and tormented the family’s two Yorkshire terriers. He would often leave the dogs tied up for hours outside in extreme weather. He put one of the dogs in a bowling ball sized bag and zipped it up. Adrianne and her daughters would be awoken by the dogs’ terrified yelps.

Adrienne filed for divorce on 1993 on the grounds of ‘extreme cruelty’.

Murders and Arrest

Cullen’s crimes spanned from 1988 to 2003. He hacked drug protocol and intentionally provided an overdose of medications to patients; medications that were normally employed to save lives. He would spike patients’ IV bags at random or administer lethal injections, killing them.

Despite the hideous crimes he secretly committed, Cullen was appraised by colleagues, and the hospitals he worked at gave him fantastic reviews when he applied for jobs at other hospitals, hence the title of the book.

His first killing occurred on June 11, 1988, at St. Bernabas Medical Center. Cullen administered a lethal overdose of medication in a patient’s IV bag. He gave another patient an overdose of insulin, also by putting it in the IV bag. Both patients died. An internal investigation into the contaminated IV bags pointed to Cullen, but no charges were filed.

Cullen resigned from St. Bernabas Medical Center and began a job at Warren Hospital. Here he murdered three elderly women by supplying an overdose of digoxin. A cancer patient complained that Cullen injected her with some medications, although Cullen was not her assigned nurse. Cullen passed a lie detector test performed by the hospital so the charges were dismissed.

While at Warren Hospital, in 1993, Cullen befriended coworker Michelle Tomlinson. Cullen took her out to dinner and then become obsessed with her and harassed her. He bombarded her with phone calls and even proposed to her at work. He went as far as to break into her house one night while she and her son slept. Cullen was arrested for stalking. He pleaded guilty to trespassing. 

At his next place of employment, Hunterdon Medical Center, Cullen followed his familiar pattern of giving patients an overdose of digoxin.

Cullen was treated for depression while working at Warren Hospital and Hunterdon Medical Center.

Cullen started working at Lehigh Valley Hospital in 1999. Here he committed a murder and attempted another.

Cullen joined St. Luke’s Hospital after resigning from Lehigh Valley Hospital. He worked in the critical care unit where he murdered patients. Colleagues suspected Cullen was up to something when they discovered vials of medicines in disposal bags. Cullen was forced to resign in 2002.

In 2000, while at St. Luke’s, Cullen attempted suicide.

Cullen joined the Somerset Medical Center in 2002. As the number of his crimes increased, authorities grew suspicious. Homicide detectives Dan Baldwin and Tim Braun were assigned to look into the matter. Computer records revealed that Cullen had requested medications that were not prescribed for his patients.

With the help of Cullen’s friend and co-worker Amy Loughren, detectives were able to gather evidence regarding the crimes. After a month-long investigation, police collected critical evidence and Cullen confessed to murdering patients at Somerset. He told detectives that he had killed about 40 patients between 1988-2003. However, it’s estimated that Cullen killed up to 400 patients during his sixteen-year crime spree in nine different hospitals.

Cullen was arrested on December 15, 2003.

Sentencing

Cullen agreed to help prosecutors identify his victims and, in return, he avoided the death penalty. Cullen pleaded guilty to 7 counts of murder and 3 of attempted murder in Pennsylvania. He pleaded guilty to 22 murders and 3 attempted murder counts in New Jersey.

On March 2, 2006, Cullen was sentenced to 11 life terms, totaling 397 years for 22 murders.

Doing a Good Deed?

In 2006, Cullen donated a kidney to his ex-girlfriend’s ill brother. He stated that he didn’t do so to reduce his sentencing and acknowledged that he killed patients so it’s odd that he wants to help someone. Cullen stated that he wanted to do something positive and he was very much intent on making it happen. He killed patients at random with zero compassion or regret, no tears, yet donates a kidney? The transplant did occur, more in secret, in which Cullen was given a different name at the time of the transplant. While I am glad that a man’s life was saved from Cullen’s donation, I can’t get over all the killings he committed. I don’t know how I’d feel if one of my family members was a victim of a serial killer and then to learn they donated a kidney to a dying individual. It completely contradicts his actions and behavior.

Cullen’s Motive

Cullen gave multiple reasons for his killings. He stated that he committed these crimes to end the patient’s suffering. But not all patients were terminally ill. I think he did it because it made him feel better. After all, he suffered from mental illness and fought depression. His acts may have given him a “good feeling.”

Targeting at Random

Many serial killers have a victim ”type.” Cullen didn’t. He choose at random and acted on impulse. He also switched up his drug choice and method of killing. Both made it hard to pin him for the murders.

The Hospitals

Many hospitals suspected Cullen was the blueprint of patient deaths, but he freely moved from one hospital to the next, carrying out his crime. Back then, there was a lack of requirements to report suspicious behavior by medical staff. There was also inadequate legal protection for employers.

Fortunately, New Jersey and Pennsylvania, as well as 35 other states, have adopted new laws, encouraging employers to give honest reviews of employees’ job performance and providing employers legal protection when they provide a truthful employee appraisal.

My Review and Rating

The book provides details like the names of patients, the hospitals, and his coworkers. It details the methods he used to kill patients, and steps into the behaviors of Charles, including his lack of emotion, his many suicide attempts, failed marriage, and stalking behavior, all evidence that he’s mentally unstable.

The one question on my mind constantly was, “Why? Why did he do this?” While I mentioned this topic above, I think it’s important to dive more into mental illness.

Cullen struggled with mental illness. My jaw dropped when reading that his first suicide attempt occurred at the mere age of 9. I immediately wanted to know what steps or actions his mother took to get him help. My assumption is she did nothing. In the 1960s and 1970s, there was a stigma on mental illness and it was a taboo subject. Many brushed it off and refused to address it. His mom may have thought her son was simply acting out as children do. He was also bullied during his childhood and his mother may have saw that as kids just being kids.

Another possibility, but I don’t think as likely, is his mom may have felt overwhelmed and missed it. Cullen was the youngest of eight children and his mom became a single mother when Cullen was only seven months old. Maybe she was swamped taking care of her kids and couldn’t give them the proper attention.

I think the latter is more plausible. Neither are acceptable excuses. But possible explanations.

Fortunately, mental health stigma and discrimination have decreased over the years and the topic of mental health has become much more visible. Society has become better equipped to respond to individuals’ needs. We’ve also come a long way with normalizing discussions about mental health and that needing help in difficult times is nothing to be embarrassed about. Despite the progress, those suffering from mental illness may feel embarrassed, as if their illness is a deep and shameful secret. Hopefully, medical experts and society as a whole continue onward to address the subject and work to find successful treatments and programs to help individuals overcome this.

Next, I want to touch on Cullen’s lack of a father figure. As I mentioned above, Cullen’s father passed away when he was only seven months old. Fathers have a profound effect on child development. Kids without fathers are at a big disadvantage and often suffer lasting damage. They are more likely to display problems in cognitive, social, emotional, and psychological adjustment. While the lack of a father figure is not the only risk factor, it can have a profound effect on a child’s development. I believe Cullen was negatively impacted by his father’s (unintentional) absence.

The Hospitals Failed, Big Time

Without a doubt, the hospitals are at fault, too. The protocol may have been different in the early 2000s, but what about the moral obligation of medical staff to care for patients? If suspicious activity is occurring and patients are dying at the same time, report it and investigate it. It seems hospitals were more concerned about saving their reputation than protecting patients.

So many questions ran through my mind while reading this book, mostly regarding Cullen and the thoughts that consumed his mind as well as the thoughts of the medical staff. I love a book that gets me thinking. Again, I appreciate the chronological order of events.

I gave the book a 5-star rating.

GoodReads rates the book a 3.81/5.

If you’ve read this book, share your thoughts in the comments!