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the good nurse

4 november 2016

Charles Graeber's Good Nurse is an unevenly-written book, but a consistent page-turner. Graeber presents a great deal of research on Charles Cullen, a mysterious and prolific serial killer, very clearly. But The Good Nurse changes styles quite often, and at times seems to model itself more on crime fiction than on non-fiction or even on crime journalism. It seems to be the definitive study of Cullen, though, and as such is a scary and thought-provoking look at a corner of the American medical system gone mad.

Cullen killed perhaps two score, perhaps several hundred patients at hospitals and other facilities in Pennsylvania and New Jersey over a 15-year span starting in 1988. How could this happen? Graeber untangles a web of terrible circumstances. A troubled, clever nurse, determined to kill and cover up his killings, but without the more classical motives of mercy or power. (Graeber alludes to killer nurses being so prevalent that the FBI has special profiling protocols set up to account for their action, but Cullen seemed to fit none of them.) Hospital administrations bent on making sure that their facilities were rated highly, and to that end, not so much covering up for Cullen as severing ties with him and seeing, hearing, and speaking no evil – whereupon someone else would hire him and the killings begin again. The impenetrability of medical bureaucracies – including paranoia about patient privacy – that prevented homicide detectives, for a long while, from even seeing the methods that Cullen used to kill. The assembly-line nature of modern hospital care that allowed Cullen to hover around patients unsuspected, even when they weren't assigned to him.

I've been in hospital myself recently, and if you've been there and remember the experience, you give yourself over in complete trust to nurses. You have no idea what's wrong with you, and you are often in great pain, or unconscious, or apprehensive of the unknown. Cullen capitalized on these dynamics to sucker-punch patient after patient, slipping them a plethora of different drugs that at times mimicked lethal natural causes. The patients would go into "code." Sometimes Cullen would show up, but rarely trying to be the hero of the crisis he'd created. Often he'd have the "code conversation" with their families: you know, it's terrible, but it happens; grandma is fixing to die no matter what we do. Except that morning, she'd been on the road to rehab.

Cullen apparently loved to lotion up living patients and wrap dead ones. He was, as Graeber's title suggests, in some weird ways a good nurse. He might kill you, sure, but if you were actually assigned to him the odds were probably lower. You'd get attention from someone fanatical about every aspect of his work. Unfortunately he considered channeling the Angel of Death part of his mission.

As I said, the book is uneven. The Good Nurse lurches from matter-of-fact background exposition through calm storytelling to vivid dialogue scenes to police-procedural patter to plumbings of the depths of its characters that seem like pastiches of Dostoevsky. I don't know what all these styles are doing in the same book. But I kept with it (despite the fact that it spoils its own "plot" early on) because of the fascinating horror of its central situation.

Graeber, Charles. The Good Nurse: A true story of medicine, madness, and murder. New York: Twelve [Hachette], 2013.