The Good Nurse: A True Story of Medicine, Madness, and Murder (33 page)

Standing by the doors, Charlie was the first and often the only person to see the runner from the pharmacy. Charlie always caught the runner; he was helpful like that. He always relieved the runner of his delivery tote of drugs. At the time, it had seemed like Charlie was the nice guy, saving the runner a trip, stocking the unit, doing his busy work. Now she saw something else.

My God
, Amy realized.
Charlie didn’t have to touch the Pyxis system at all.

51

A
my pored through the paperwork that night till her eyes cracked. She brought the paperwork to bed with her, fell asleep with it, and read it in the morning before heading out for the long commute south, to use the Pyxis herself, another long weekend of overnight shifts.

Amy tried not to think of herself as being a traitor, but every day, it was more difficult. She had broken rank and felt unbearably at risk of being fired by the very institution she was working to improve, and utterly alone in the stress of that. She was still a nurse, but only the detectives understood her full identity. Tim and Danny were almost always working late now; Amy would swing in after her shift, share a coffee while handing off another stack of paperwork. Seeing the detectives working made Amy feel a little less alone, a little more brave.

It had been Amy who first told the detectives about the Cerner patient records. The SCPO investigators would want those records, unmolested and in full. Detective Douglas Brownlie had started the paperwork for the subpoena. Meanwhile, Amy had another way.

She felt something like the guy in that Johnny Cash song, the one where the auto worker brings a new car part home in his lunch box every day for twenty years and ends up with a full Cadillac. Except Amy didn’t have twenty years to pull all of Charlie’s Cerner records without anyone noticing. Instead, she brought a bigger purse to work.

Apparently, none of her coworkers had noticed how lengthy her Cerner printouts had grown; the privacy of the night shift afforded such liberties. Amy read through them quickly on the screen during her shift, then thumbed the pages, more slowly, alone in the car. She told herself it wasn’t suspicious—a nurse, in a nurse’s scrub uniform, parked by the roadside
reading medical charts, but she knew it was suspicious, of course it was. These days, she seemed suspicious even to herself. She was trying to track Charlie down, figure out his methods of murder, if in fact he was a murderer. But in the process, she was acting like Charlie, too.

The slide between the Friday shift and the Saturday shift was easy: out by 11:00, home by 1:30 or 2:00, and a whole Saturday with the kids before heading back for the overnight. But by Sunday she was always exhausted, this Sunday more exhausting than most. Amy sat at the nurses’ station for report, feeling like an imposter. She didn’t trust herself tonight. She was nursing in a crime scene, but too tired either to nurse or investigate. Working with the prosecution had made Amy skittish. She was scared for everyone now, including her patients and herself. The stress soon crystallized into a splitting headache.

Amy walked to the Pxyis machine to order up a Tylenol, then just as quickly stopped herself. Everything was so loaded now, even the most usual things. Even pulling out a frigging Tylenol in a hospital.

Nurses called it self-dispensing. You wouldn’t really call it a secret, but it wasn’t exactly in the brochure. When a nurse needed an aspirin or a Tylenol for herself, she would often pull the med out of the Pyxis machine. It was a little thing, like a waitress eating a French fry off a plate. Amy fretted over her karmic bank balance daily, but had never been bothered by this. So why the huge guilty rush? Now she was angry with herself—it was just a Tylenol, for chrissake, so her head didn’t fall off while she worked her ass off on the overnight. Amy decided, Screw it, she’d work with her teeth gritted.

Amy pressed Cancel on her Pyxis acetaminophen order. Of course, the drawer popped open anyway, and she instantly thought of Charlie as she bent to shut it, and another guilty wave twisted up her breathing. And then she stopped, and looked. There was the Tylenol, in its little cassette. The dig was in the same drawer, practically neighbors.

It would be that easy. As she went back through his Pyxis requests, it all began to make sense to her. The information had been in the computer the whole time. He wasn’t always ordering dig; he didn’t have to. He could order Tylenol. The dig was in the same drawer.

After her shift, Amy returned to the beginning of the Pyxis stack. The detectives were trying to convict Cullen for the murder of Florian Gall, focused on him and the dig. The problem was, the dig orders didn’t match up with the dig deaths. But the Tylenol orders did. Maybe there was no way
to prove he’d ordered one thing and taken another, but no nurse would look at his pattern of Tylenol orders and not find it bizarre. Amy couldn’t help wondering if she was the first at Somerset to notice them.

The Tylenol orders weren’t the only odd pattern. Studying the Pyxis again, Amy found other curious combinations of drugs that Charlie had consistently ordered. Nitroprusside. Norepinephrine. Nitroglycerine. Pavulon. The list went on and on, sometimes half a dozen in a night. Amy knew these drugs to be more commonly used in a cardiac unit. Charlie was working in Intensive Care. His orders emptied the drawers. Then, time and time again, Charlie ordered a restock from the pharmacy. His position in the hall with the Cerner meant he’d be the first to take the delivery. At the time, he was seen as being helpful. Now Amy wasn’t so sure. The refill orders were unusual, and showed up on his Pyxis. The Somerset Medical Center attorney, Fleming, had asked Charlie about that, as he’d asked about his frequent cancellations. But had anybody asked Cullen what he was doing with all that heart medication?

Before bed, Amy picked up the phone to tell Tim. He and Danny were trying to trace a single gun; she thought the Pyxis was pointing to an entire arsenal. She still didn’t know what he was doing with it all.

Amy went back to the bathroom, making a basin with her cupped hands and lifting the frigid well water to her face, but her heart palpitations were not irrational. She’d been looking for answers to who her friend really was. The answers had been there, on the pages of Charlie’s Pyxis data, and the distinct pattern of drug combinations he’d ordered.

They were combinations which, from a physiological perspective, complemented each other, fitting toward a purpose the way individual notes contributed to a chord or an apparent disharmony of multiple boozes combined into a cocktail. It all made a terrible sense now. Amy needed to sleep, but she was afraid to dream.

52

A
my laid out her new discoveries across the table for Tim and Danny the following afternoon. Charlie had been bartending, she told them, titrating a pharmacopeal mélange, from both drugs he’d pulled from the Pyxis machine’s cabinet and drugs he hadn’t.
¹
Each drug in the cocktail had a specific biochemical effect. Together, they were a biochemical symphony. In combination, it didn’t require nearly so much of any one drug to push a vulnerable patient over the edge. One drug pushed while the other pulled.

Only the patient’s reaction mattered. The gap of time between the serving of the cocktail and the patient’s reaction was suspenseful. There might be a crash or a code or a Lazarus-like recovery. The cocktail was the riddle and the lab reports were the answer.

She had imagination enough to make sense of the patterns, but she couldn’t begin to imagine the monster that amused itself with them. All she was certain of was that it wasn’t the same gentle soul who was her friend Charlie. The emotional disconnect bothered her as much as the murders themselves.

Amy considered herself to be a perceptive person—a spiritual traveler, a listener with well-tuned antennae for the frequency of vibes. Growing up as she did, she had always assumed that if she was near another monster she would feel it. And yet, standing next to Charlie, she had never felt anything like evil. Maybe she’d gotten him wrong, or maybe her antennae were broken. Or maybe, Amy thought, she was half blind, and could see only the good in people.

C
harlie’s Cerner pages comprised all of the charting he had done at Somerset. Each page told her she had assumed wrong. Charlie was not, actually,
the world’s greatest nurse, the greatest chart keeper Amy had ever seen. He had hardly typed a line.

It was, in fact, the
worst
charting Amy had ever seen. There were blotches of words here and there, blurts, spasms of hurried and misspelled observations. It couldn’t have taken him more than a minute to do that work. Whatever he was doing on the computer, it wasn’t input. That meant Charlie had been outputting something.

Amy had to wait until her next shift to print out the rest of the records. This time, she couldn’t wait until she got home. That morning she called ahead, then brought her paperwork to the second floor of the prosecutor’s office to share her discovery with the detectives.

The Cerner automatically kept track of everything a nurse did within the system, and provided a time and date stamp of every page a nurse had browsed. Charlie was browsing all night. That was what he was doing.
Browsing.

The word dragged a fingernail up her arm.

I
n her dream that night, Charlie was standing by the Pyxis, laying out the IV bags. Helpful. He did this alone.

There were patients on the ward, listed on the whiteboard. Strenko, Simco, Strickland, each with a number. The room numbers were a kind of lottery; the nurses worked different numbers every day. Some nurses thought certain numbers were lucky and played them in the lottery. Some of the numbers reflected on themselves, front and back, like 212. Some were birthdays if you were born in February.

Now Charlie’s at the Cerner. On the screen is a patient, not his. Now another patient, another.

The nurses are in the rooms, tending the cells. Charlie is in his. He draws the shades and closes the door and pulls the horseshoe curtain around the patient. Why so secret? Is Charlie in the room? Which room? He has three patients in three rooms. All three blinds are closed. It could be any of the three. It’s like three-card monte. Where’s Charlie? But he’s not in the rooms. Charlie is at the nurse’s station, pulling drugs. Why so many? He’s alone at the Pyxis, but he’s not using the Pyxis. Why so often? Another nurse needs to pull a drug and Charlie offers to do it for her. Why so helpful?

On top of the Pyxis, Amy can see the IV bags, clear little udders in a row. Each has a sticker with numbers and letters, ten-point type, you’d need your glasses to see. Is he wearing his glasses? He is not. Charlie is vain. He’s handsome. He can’t see.

You’d have to slow down, stop, study the bags to figure which goes to which patient. Does he? He has the cocktail in his hands and he sticks one. Does he know the name or the number? Does he know where it goes?

He’s back behind the Cerner computer cart now, a new patient up on the screen. Then another. Then another. Why so many, Charlie? What are you looking for, hon?

Charlie, what are you looking for?

Charlie doesn’t know. That’s why he’s looking.

It’s a lottery.

Amy’s awake.