It was his shyness that struck her first. “He was so soft-spoken that immediately I felt like I needed to protect him and my protective nature kicked in right away,” Amy Loughren recalls of Charles Cullen. “I knew that he was brilliant. His knowledge of medications, his knowledge of critical care was outstanding, and I’m drawn to people that are smarter than me. And he laughed at all my jokes. So we were fast friends.”
What Loughren did not know was that Cullen, a fellow night nurse, was murdering patients by secretly administering drug overdoses. But she would eventually help detectives catch her colleague and friend and put him behind bars. Today he remains, by some estimates, the most prolific serial killer in American history.
Loughren and Cullen’s platonic relationship is at the centre of The Good Nurse, a Netflix film directed by Tobias Lindholm and starring Oscar winners Jessica Chastain and Eddie Redmayne. It is a study not only in a mass murderer’s ultimately unknowable motivations but also an indictment of a profit-driven American healthcare system that turned a blind eye even when red flags were raised.
Loughren, a single mother, had her own negative experience of that system. The travel nurse at Somerset medical centre in Somerville, New Jersey, concealed the fact that she suffered cardiomyopathy (a disease of the heart muscle) because she knew that, if she missed more than six days of work, she would lose both her health insurance and her job, leaving her unable to take care of her family or pay for her medical care.
But she found a sympathiser in Cullen who, on joining the ICU, helped share her workload and cover up her illness. Speaking via Zoom from Florida, Loughren explains: “He was one of the only people that knew about it and he really did understand what it meant for me if it got out that I was too sick to be working. He certainly helped me on those nights when I wasn’t physically capable of being there completely.”
Thrown together in an intense situation, the pair bonded. “When you’re on life and death you become very close and, whether it’s healthy or not, sometimes nurses see each other more than they see their own families because we work really long hours. Night nurses especially tend to just not have much of a social life because all we want to do is sleep when we’re home. So we tend to use our co-workers and our colleagues as our social life.
“Did I notice a dark side? I noticed that perhaps he was depressed, maybe that he was kind of like me and suffering from childhood trauma.” (Cullen’s father, a bus driver, died before Cullen turned one year old; his mother was killed in a car accident when he was a teenager.)
But there was never a hint of romance between them. Loughren, 57, comments: “Charlie knew his limitations. One of the reasons that we did have such a deep friendship was because there wasn’t any of that. We were so close because I was never concerned about that and there was never any boy-girl stuff going on ever.”
When word got out that the hospital had drawn the attention of law enforcement, Loughren still had no notion of what was afoot. She wondered if some drugs had been stolen. Interviewed by a detective, her instinct was to defend her friend. “I was saying, ‘You’re full of shit. There’s absolutely no way that my friend Charlie – if you’re asking questions about him, I’m not cooperating.’ He was like, ‘Yeah, that’s our job.’”
After the detective presented Loughren with evidence of the specific medications that Cullen had removed, she realised it could only have been for sinister reasons: there was no other explanation. Finally, the truth had dawned. She understood what her friend had been doing to the patients entrusted to his care, devastating their families.
She says now: “That’s where all of my guilt comes in. Hindsight is 20:20. Until the detectives showed me the evidence, I didn’t know, I didn’t become suspicious. I was able to look back when I did see that evidence and then things started coming out and I started to remember certain incidents where I knew he probably did something, except I wasn’t questioning him in that way.
“You don’t question another nurse when they make a specific decision when you know that they’re a very skilled nurse or they’re very seasoned. You might think, ‘That may not be the same decision I would make; however, they’re a good nurse, they have their reasons.’
“Yes, there were a couple of head tilts when we were in code together or when I would walk in on him and a code had already started and he would have given a certain medication that I thought, ‘That’s odd, we don’t use that medication any more in our protocols, why is he using that medicine?’ He was so good at what he did, I never thought, ‘Oh, he’s trying to harm someone.’ Why would anyone think that?”
Loughren felt sorrow for the victims and scared for her job. She agreed to work with the detectives to bring Cullen to justice. There were some “tough” phone calls with him as investigators listened in. Ultimately she met him at a diner while wearing a wire and could feel her pulse quickening, a potential danger given her heart condition; the wire picked up the sound of her heartbeat. She confronted Cullen and got a partial confession; the wire malfunctioned but there was enough information to arrest him.
Given their close friendship, did she feel mixed emotions? “Absolutely. I didn’t really meet the murderer; I didn’t know this person that could kill people. It was very hard for me, betraying him, betraying a friend in that way.
“My integrity is pretty damn intact. It’s very hard for me to fake any emotions. When I went in to talk to him, those emotions were real. I genuinely cared for him and I know the only reason that we were able to actually get him to confess was because he did feel comfortable and he did care about me. At least I thought so. I would like to think so. I would like to think that person was real and they were two different people.”
Cullen was arrested in 2003. He confessed to killing up to 40 patients and was sentenced to 11 life terms. Investigators believe that the real number of patients he murdered while pinballing between nine hospitals in New Jersey and Pennsylvania over 16 years could be up to 400. At the first hospital where he worked, for example, he injected fatal drugs into IV bags that went out to patients at random; he once admitted to poisoning three to five such bags per week.
Loughren visited him in prison but did not get the answers she wanted. Once he discovered her part in his capture, all contact between them ceased.
She reflects: “It’s been almost 20 years and the person behind bars is the murderer; it’s where he needs to be. Holding him accountable for everything that he did is the only way that any of us can move on and any of the victims’ families can move on. He deserves to be behind bars. I also believe that he had mental illness that went unchecked and he cried out for help so many times and was not given the help that he needed, which also says a lot for our healthcare system.”
The Good Nurse makes a persuasive case that, as he switched from hospital to hospital, Cullen was able to conceal his lethal poisoning – with overdoses of medications such as insulin and digoxin – of patients in intravenous fluids thanks to for-profit hospitals covering up potential liability. This is in the context of a notoriously laissez-faire US healthcare system that sees an estimated 68,000 people die each year because they cannot afford the help they need.
Loughren, who retired as a nurse last year and helped Chastain prepare to play her on screen, adds: “Once we started capitalising on people’s suffering, we lost our soul and those patients stopped being human. Those patients became a dollar sign. Those patients became a diagnosis. Those patients became also something to exploit. The decision makers are so far away from the bedside now, they don’t care. It is definitely a symptom of the dark capitalism that is our healthcare system.”
The perils of running hospitals like businesses underpins journalist Charles Graeber’s 2013 book, The Good Nurse: A True Story of Medicine, Madness and Murder, based on meticulous research and interviews with Cullen (“a sad Mr Rogers type, both drippy and depressed”) and Loughren, and a key source for the film. Asked about his motivations, Redmayne’s Cullen replies: “They didn’t stop me.”
Graeber recalls from his conversations with Cullen a sense that the hospitals were negligent in their responsibility as protectors and healers of vulnerable patients. “Certainly in his estimation, the hospitals knew what he was doing – some of them at least had a very strong sense of what he was up to – and, rather than gain a full understanding or deal with the proper course of action, they would give him positive or neutral references and simply move him on to be someone else’s problem.
“He felt that this dereliction of duty exposed a hypocrisy in his employers that he himself highlighted, as if he was almost a critique of the system. He would never say it in this way but he felt in some way justified.”
Speaking by phone from Nantucket, Massachusetts, the 53-year-old author adds: “I wanted to highlight the difficult work nurses do and the good work that good nurses do all the time and how thin they are stretched in a for-profit system. The healthcare system does extremely well for itself and, for those who can afford it, it is some of the finest care in the world, certainly.
“But in terms of serving the whole of the country, the whole of those who need it, it seems that its corporate identity and for-profit interests cloud the judgment of some of those who are designed to run or protect those institutions and it fails ultimately patients and it treats many frontline healthcare workers as interchangeable parts. Charlie’s story highlights that. It’s ironic that he is actually in this way correct: what he did is wrong but, as a critique, I can’t imagine a more poignant one.”
The Good Nurse is available on Netflix now and a documentary, Capturing the Killer Nurse, will stream on Netflix from 11 November