Could it be that you have never heard of the most prolific serial killer in American history? If it is true that Charlie Cullen is responsible for hundreds of deaths and his name is unfamiliar, then yes. Cullen was a nurse who spent more than 16 years torturing and killing patients with potent mixes of drugs. Even though he was suspected in many medical incidents at a handful of hospitals, it was years before he was criminally investigated. It took two intrepid detectives and the fellow nurse who may have been his only friend to finally bring him to justice. Cullen’s scary tale is the subject of journalist Charles Graeber’s true crime work, THE GOOD NURSE. While it leaves many unanswered questions, the book succeeds in painting a picture of mental illness, murder and the cover-ups that allowed Cullen’s spree to go unchecked for so long.

"Graeber presents his subject with an objectivity that refuses to romanticize him, and does a good job presenting the themes of moral ambiguities and ethical responsibility that is the flip side to Cullen’s killing."

Unlike many true crime books, Graeber doesn’t unpack his subject’s personal history in detail. Readers get only a glimpse into the dangerous and tense household in which Cullen was raised: he was the youngest of many siblings raised in a house that was “a dark, unhappy place haunted by drug-addicted brothers, adult sisters who drifted in and out on tides of pregnancy or need, and strange, rough men who came at all hours to visit them both.” Cullen’s father died soon after his birth and his mother when he was in high school, leaving him essentially alone in the world. 

It is his mother’s passing that seemed to have been the catalyst for his obsession with hospital death. After a stint in the Navy and then nursing school, Cullen found himself working at the hospital where she died. His time in the Navy appears to have been marked by severe hazing, depression and suicide attempts as well as strange behavior, but later he was popular as the only male nursing student in his class and completed the coursework successfully. Once in his chosen career, however, Cullen began to inflict pain on his patients with deadly combinations of medication, ultimately causing their deaths.

Most of THE GOOD NURSE is focused on the years Cullen spent killing in a variety of hospitals in New Jersey and Pennsylvania and the police investigation that finally stopped him. The most compelling aspect of Graeber’s book is the fact that many people, including other nurses and patients’ family members, had suspicions about Cullen for years. And more than that, hospital administrators had investigated him time and again, only to fire him for other reasons and then go on to give him recommendations for other nursing jobs. When police detectives, along with agencies like Poison Control, finally step in, they find years of hospital cover-ups that, while serving to legally protect the hospitals, allowed Cullen to continue to murder patients at an alarming rate and in a blatant fashion.

There is never much motivation presented by Cullen’s murders; clearly he is unstable and depressed. Perhaps he suffered abuse growing up or is a sociopath, but Graeber doesn’t speculate for the most part. While more background or analysis would’ve improved the book, it is chilling enough even without that information. Graeber’s characterization of the two lead detectives and the confidential informant who brought Cullen down also makes for a good read. Not always smoothly written or intellectually satisfying, THE GOOD NURSE is still fascinating and frightening. Graeber presents his subject with an objectivity that refuses to romanticize him, and does a good job presenting the themes of moral ambiguities and ethical responsibility that is the flip side to Cullen’s killing.

This is a scary page turner about one man’s quiet reign of terror, those dedicated and brave enough to end it, and the dangers that can lurk in the places we may feel safest.