Who Enabled ‘The Good Nurse’?

Dark, gripping Netflix thriller could have been a little harder on medical bureaucrats

At the time of this writing, one of the most popular new movies on Netflix is The Good Nurse, based on Charles Graeber’s masterful book about the crimes of Charles Cullen, who worked night shifts at Pennsylvania and New Jersey hospitals and deliberately injected excessive doses of insulin into patients’ IV bags, killing 29 people we know of and possibly many more.

The adaptation features Eddie Redmayne as Cullen and Jessica Chastain as Amy Loughren, a fellow nurse and single mom who lets the intense stranger into her messy personal life. It’s a noirish piece of filmmaking, full of overcast landscapes, dim interiors, and close-ups of the faces of its principals. This thriller’s relentless grimness and institutional settings may make you think of The Silence of the Lambs, even if its villain is plain spoken and lacks any taste for Chianti, classical music, poetry, or the architecture of Florence.

While The Good Nurse is gripping and never less than watchable, it seems narrower in its aims than the book and may leave viewers who are unfamiliar with its source without a sense of the scope of Graeber’s achievement. For this critic, the book evokes Truman Capote’s In Cold Blood. The voluminous research and interviewing undertaken by Graeber over many months are evident on every page, yet he doesn’t bash you over the head with his erudition. Facts about Cullen, and, critically, the lapses in oversight that allowed him to go on working in hospitals without detection and carry on his bloody reign of terror, are woven into a narrative in which Graeber describes, with the sensibility of a poet, the bleak institutional buildings and snowy, gothic landscapes of the blue-collar milieus in which Cullen lived and worked.

Abdication of Duty

Charles Cullen grew up in a house full of siblings who abused drugs and never knew his father, who died when he was quite small. Graeber presents these facts without excusing anything Cullen went on to do. The film renders Cullen largely as a cipher. Amy likes the young man, and is grateful to him for providing a bit of stability in her life, until it emerges that he’s a serial killer. Oops.

Cullen was a monster, but he was not the only one to blame for the deaths of at least twenty-nine hapless patients. One of the most chilling things documented in Graeber’s book is the indifference and incompetence of those involved in the staffing of hospitals where patients’ lives were on the line and where highly specialized knowledge, training, and qualifications were imperative.

Graeber details the failure of one employer after another to take elementary steps to screen Cullen as he walked off the scene of a crime and set out to get a fresh start at another hospital and proceed to commit more murders. References did not undergo proper review. In some cases, the rubber-stamping of Cullen’s job application fell under the aegis of a staffing agency.

When Cullen applied to join the team at Liberty Nursing and Rehabilitation Center in Allentown, the process went through an agency called Health Force which, according to Graeber, received confirmation that Cullen had worked previously at Morristown Memorial Hospital and did not get any further information from that former employer. You worked there from this date to that date? Okay, fine. Cullen’s new prospective employer, and the patients and families who depended on the care that Liberty provided, might have taken an interest in the fact that Cullen got fired from Morristown Memorial after complaints from patients and what Graeber calls “grave medication errors.”

At another former employer, Hunterdon Hospital, one of the head nurses, Marjorie Whelan, had threatened to fire Cullen for badly messing up medication and patient care. So what turns up on his Liberty application? “The Liberty HR reference form would record that Charles Cullen was ‘an excellent nurse, gave good care, was excellent with patients,’ and that Whelan would recommend Charles Cullen for employment,” Graeber states.

Here are some of the most important aspects of the Cullen story, pregnant with implications, but they are largely absent from the film.

Graeber and Capote

The Good Nurse is as finely written as the most famous “nonfiction novel” of the last century, In Cold Blood. But where the author of the latter book goes far—much too far—in his plea for understanding and empathy for two killers who had hard lives, Graeber gives a frank account of Cullen’s troubled life without falling into the trap of trying to evoke sympathy for a monster. The reader will come away with no illusions about what it was like to be Cullen, but will also understand the singular vulnerability of sedated and immobilized patients which Cullen exploited to commit horrific and cowardly crimes. The irony of the title is resonant.

The movie chillingly depicts the ruthless actions of a disturbed man hell-bent on murder, and presents a thrilling police procedural as the investigation progresses. It also, perhaps inevitably, presents a handsome young actor in its lead role, someone who does not look too much like the person he is based on, and shows his softer side as a romantic interest for Amy and, in certain scenes, as a surrogate dad for her troubled young daughter. And while the Netflix film is slick and effective, it could have delved a bit deeper into the implications of the issues it raises.

You will have to turn to the book to find a deeply thought-provoking experience, one that will prompt you to reflect on Americans’ tendency to trust people in positions of authority out of an unthinking and near-religious reverence for those who couch their edicts in the lingo of science and medicine. Contrary to what Mehmet Oz proclaimed in a recent ad, solving problems and helping people is not necessarily what doctors, and nurses, do.

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Michael Washburn

Michael Washburn is a Brooklyn-based writer and journalist and the author, most recently, of The Uprooted and Other Stories (2018), When We're Grownups (2019), and Stranger, Stranger (2020). He's also host of the weekly Sea of Reeds Media podcast, Reading the Globe.

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