The Good Nurse: A True Story of Medicine, Madness, and Murder

In June 1987, Charlie works in the burn care unit of the Saint Barnabas Medical Center. There, victims of fires come for specialized care, and Charlie’s job is to clean burn wounds. The author describes the trauma of burn wounds, as well as the “rule of 9s,” which calculates a victim’s likelihood of survival. Because of the pain associated with burns, nurses administer morphine and on occasion inadvertently administer a lethal dose. Charlie connects most to the children, many of whom arrive at the hospital because of abuse, and reflects on his own childhood, when he was abused by his sisters’ various boyfriends. The author describes different treatments for children who have burn wounds. Charlie grows comfortable in the burn unit, building relationships with the veteran nurses. He reflects on sainthood and the hospital’s patron saint, Saint Barnabas.

In October 1987, Charlie and Adrianne purchase a small house. The couple work opposite schedules, and increasingly Adrianne feels an emotional distance between them. Charlie begins drinking, something he quit after his time in the Navy. He uses their boiler room to drink. They have a child, and their relationship grows even more strained as Charlie dotes on the baby and ignores Adrianne. One day, their puppy escapes, and Charlie claims that he was on a walk while the baby slept. Adrianne begins to suspect his actions. She becomes increasingly uncomfortable and afraid of him. Her suspicions heighten when their neighbor arrives in tears because her dog was poisoned. Adrianne later finds pictures from their daughter’s daycare and sees that Charlie has cut all the little boys out of them.

In February 1991, a nurse takes a suspicious IV bag to the Saint Barnabas Medical Center risk manager. It’s then taken to Thomas Arnold, the assistant director of security, and they discover that it contains insulin when it shouldn’t. Three days later, a patient is started on a heparin drip but immediately experiences high insulin levels. She’s treated and the drip is removed, but that afternoon, when it’s re-established, she experiences spikes again. A second patient experiences the same insulin spikes when hooked up to heparin. His bag is sent for testing and is found to contain insulin, which has seemingly been intentionally injected given the puncture marks on the bag. The hospital risk management team looks through patient records and finds a history of insulin spikes and patient codes across several of their care units. However, they find no evidence of a nurse accidentally administering insulin because nothing is noted on any patient files about such a mistake. Joe Barry, head of security for the hospital, realizes that Charlie was working during most of the codes.

Hospital security interviews the nursing staff. Charlie’s attitude is dismissive and rude; Arnold immediately suspects him but has no proof of Charlie’s culpability. Arnold and Barry find more questionable cases the harder they look, but nothing directly links Charlie to the insulin spikes. They meet with the local chief of police, who asserts his belief that this should be an internal investigation. Arnold and Barry go to great lengths to find proof of Charlie’s wrongdoing, but Charlie stops working at the hospital before they can. The insulin spikes stop with his departure.

Charlie reflects on having spiked heparin bags at random, assuming that he’d get caught and arrested. When he continues to get away with this crime, Charlie concludes that the hospital cares more about profits and reputation than the well-being of patients. He stops picking up shifts.

In January 1992, Charlie lies to Adrianne and claims that he was let go because he spoke out against a nursing strike, painting himself as a martyr. He tells her about the spiked insulin bags and claims that he was fired as a scapegoat. Adrianne has doubts about the story but doesn’t push Charlie because he seems enthusiastic for the first time in a long while. Charlie waits for an arrest, but when nothing happens, he applies at Warren Hospital in New Jersey. He quickly secures a job.

Adrianne has conflicting feelings about her distrust of Charlie, second-guessing herself because of how quickly he found new work. Although the new job gives Charlie enthusiasm, his drinking becomes obvious. Adrianne tries to give him resources to quit, but he refuses. Charlie begins to stage expressions of suffering, including fake attempts to die by suicide. Adrianne finds a divorce lawyer and prepares the documentation before having gallbladder surgery at Warren Hospital, banning Charlie from her room. Charlie is served the divorce papers at work. After Adrianne recovers from her surgery, she starts to feel sympathetic toward Charlie again, and they decide to live together until he can secure a new rental.