The Good Nurse: A True Story of Medicine, Madness, and Murder (15 page)

Like many nurses, Amy saw herself as a hero defending humanity’s most fragile, an advocate and facilitator for the voiceless and immobile. With his question mark posture, soft gray hair, and ratty old-man cardigans, the new nurse struck Amy as another sensitive soul in need of defending—a sad Mr. Rogers type, both drippy and depressed. His nurse whites had the dingy air of bachelor washing, and behind his greasy drugstore glasses his eyes held a darkness and desperation that Amy recognized as masked
anger. It took only a couple overnights together before Amy realized that Charlie Cullen was also one of the funniest people she had ever met. At 4 a.m. Charlie could make her laugh with a story or complaint that put her own crazy life in perspective. Humor and gossip provided a buffer against the suffering and grief that came with the job, and Charlie always delivered. Several stories centered on the absurdity of his Navy years, his assignment to guard nuclear missiles with a billy club, or the indignities suffered when he refused to pee into a cup in front of another man, but most involved Charlie’s girlfriend, Cathy, and her sporadic attempts to get Charlie to move out of the house. Amy called it “The Charlie and Cathy Show,” and she tuned in nightly. Eventually, she reciprocated with confessions of her own.

Each night, Charlie would zip through his responsibilities with patients and then cruise the block of rooms until he found her. Amy was a procrastinator, always running late, and she appreciated his technical proficiency, born of fourteen years’ experience
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at nine other hospitals. Soon, she came to rely on it. Her position at Somerset was the best Amy had held in her nearly fifteen years of nursing. The $20,000 bonus on salary for a seven-month contract plus $1,700 a month for local lodging was “crazy money.” She wanted to keep it, even if it was killing her.

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idshift that October, Charlie found her listing against the hard white wall of the nurses’ station. He helped her to an empty room and shut the door. Amy sat on the bed, gasping for air until she could explain. It was a funny story, at least to the gallows sensibilities of a veteran nurse; she was working in one of the nation’s top cardiac care units, and secretly, slowly, dying of heart failure.

Amy had diagnosed it herself as advanced atrial fibrillation brought on by prolonged chronic sick sinus syndrome. The condition was at least partially responsible for her crippling panic attacks and the reason those attacks were so unsettling. The synaptic wiring in her heart muscle was misfiring. The result was an erratic heart rhythm insufficient to cycle oxygenated blood between her lungs and her body. Amy was drowning in her own stagnant bloodstream. The most logical medical explanation was that her heart muscle had been ravaged by a virus from one of her patients, but Amy wondered if perhaps it was something more mystical: an emotional
virus of some kind, psychological shrapnel from the monsters of her childhood, the damage of memory. Amy’s failing heart wasn’t the only secret in her life. Those were killing her, too.

Charlie listened, nodding like a doctor. Then he left the room, returning a minute later with a mint-green oval in his palm—diltiazem, 0.5 mg. Amy popped the pill and pulled herself upright with an empty IV tree. It was just 2 a.m., and she still had work to do.

“No, listen,” Charlie told her. “You rest. Doctor’s orders.” He gave her the hint of a smile. “I’ll handle your patients tonight.”

“Charlie…,” Amy started.

“Don’t worry,” Charlie said, turning to leave. “I can keep a secret.”

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harlie never knew how many he did at Somerset, only that it started around when Amy got sick, and once it started it did not stop.

Amy’s cardiomyopathy went unchecked until February, when she collapsed at work and was rushed to the ER. She would require a pacemaker and a leave of absence. Charlie was alone on the overnight. He replaced her attentions with his own compulsions.

The specific ones, the very old, the very sick, the memorable, seemed to begin mid-January
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with digoxin and a sixty-year-old housewife named Elanor Stoecker. Two weeks later, Charlie worked the night of his forty-third birthday, and used Pavulon, a strong paralytic similar to vec. It was an effective drug by itself, but Charlie had incorporated it with others, and at the end of the night he wasn’t exactly sure who had died as a result of his actions, nor what, precisely, had killed Joyce Mangini and Giacomino Toto. He was, however, quite certain that it was norepinephrine which blew out John Shanagher’s heart on March 11. As he worked the code, Charlie’s knowledge of which drugs might reverse the old man’s sudden failure seemed, to the other nurses, almost magically prescient. Even the young residents on call stepped back to let Charlie take charge. His reputation as a code genius grew, and by the time Dorthea Hoagland’s hammering heart stopped beating and Code Blue bleated through the speakers that May, Charlie once again seemed to have the answers. Each patient had complex and interlacing issues with their organs or chemistry, and each responded uniquely. It was a busy spring, and Charlie was less interested in names than in causes and effects.

Michael Strenko was young for the unit, their only patient with hair gel, and his illness was particularly upsetting to the nurses. The twenty-one-year-old Seton Hall computer sciences student had a genetic autoimmune disease that cascaded into complicated symptoms and system failures. Amy, back on the unit from a pacemaker surgery and bed rest, was deeply worried that young Michael wouldn’t survive. Charlie was sure of it.

In the end, it had been digoxin, or epinephrine, or some combination which had put Strenko over the edge—the sick were so precariously balanced, it only took a little push, a sigh that floats a feather, a nudge so subtle and dispersed that nobody noticed the cause, only marveled at the effect. The codes that night were multiple, and not pretty. After the second, Charlie shuffled out to the waiting room to find Michael’s terrified mother, giving her a graphic and technically accurate word picture of what was happening, at that very moment, inside her son’s dying body. He explained how the EKG indicated the failing pulses in his heart, and how you could affect those pulses with drugs, norepinephrine or digoxin, up or down, depending. He told Mrs. Strenko that Michael was sick, and that sick people, like it or not, eventually died.

Michael’s parents were horrified by this rendering, and they asked Charlie to leave. But Charlie was right. And at approximately 2 a.m. on May 15, when Mrs. Strenko finally waved off the last shock paddle from her son’s exhausted body, the flatline proved it.

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he didn’t set out to make a stink, but Amy questioned everything. Amy figured, if that made her a pain in the ass, if sometimes she went too far and wasn’t nice about it, then fine, at least she wasn’t cattle. That was her, she always said so, a hotheaded, reactionary bigmouthed girl with a temper, but not cattle. She wouldn’t just go along. They heard about her all the way down in Oncology: Amy, the ICU nurse who refused the exasperating new safety protocol, the one who wouldn’t put her name on their new insulin sign-out sheet. That told her what a big deal she was making—you practically needed a shuttle bus to get from the ICU to Oncology.

They were calling the new drug protocol an “insulin adjustment form.” Her manager, Val, had explained it, trying to convince Amy to sign. Previously, the insulin had always just been there in the little fridge. But now for some reason they were changing the protocol, making the nurses more
accountable by forcing them to put their electronic signature on their guess as to how much was left in the vial. Amy thought it was inaccurate and stupid. How could she eyeball exactly how much was left? They were asking her to bet her nursing license on a jellybean counting contest. Clearly, something had happened, on her unit, possibly to her patients. Amy demanded to know what was going on, but her supervisor wasn’t about to tell her. Why treat insulin like a narcotic? Amy demanded. What was so dangerous about insulin?

When her manager wouldn’t answer, Amy refused to cooperate. Val said “Sign,” and Amy said no. “Just do it,” Val said. Amy wouldn’t.

Now Val was angry, too. Amy didn’t understand the reaction. Why the hell get so worked up over a simple piece of protocol—what, did somebody die?

Val was practically screaming as she finally told Amy, “Look, just sign it—this whole thing isn’t about you, anyway!”

What did that mean? Who was this about?

At the time, Amy did not connect the new protocol requirements with the sudden frequency of codes. All she knew was she was wrapping so many bodies now, probably more in the past half year than during her entire career. She had no idea there was a problem, much less did she imagine that Charlie, or anyone, was the cause. Charlie was a good nurse, extraordinary even. She was always glad to find his name on the whiteboard schedule. Her doctors had told Amy to take it easy, but with multiple patients under her care, easy wasn’t always an option. Often she had to choose between being careful of her own heart or tending to theirs. With Charlie on shift, she had a third option. He was never too busy to help.

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n June 14, 2003, Charlie was early by a full half hour—he couldn’t wait. He checked the computerized Cerner charts of various patients and decided on the Oriental lady.
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Mrs. Jin Kyung Han wasn’t his patient now, but she had problems. Han had come into the hospital June 12 with Hodgkin’s lymphoma and heart disease. Her cardiologist, Dr. Zarar Shaleen, had Han on digoxin already, small doses, usually 0.125 mg, keeping her at the therapeutic level of around 0.63. Her doctor had ordered another dose of digoxin for Han on June 13. Then, when he studied her EKG, he discovered that
dig wasn’t helping her new cardiac arrhythmias. In fact, it might kill her. He ordered that the drug be discontinued.

At 7 p.m., the nursing shifts went through their handoff report. Charlie was free again by 7:30, going straight to the Pyxis drug computer and calling up dig. He placed an order of the drug for his own patient, then quickly canceled it. The drug drawer popped open anyway. It was that easy. The new security protocols were stupid. Charlie pulled out two units and closed the drawer.