Free The Good Nurse: A True Story of Medicine, Madness, and Murder by Charles Graeber

hospital, and mistakes were possible anywhere. Proof of an innocent mistake would probably show up in the paper trail. The Somerset Medical administration assured the DOH they were already reviewing all their documentation systems. The hospital employed two major computerized systems; the Pyxis MedStation 2000, for the drugs, and Cerner, which stored computerized patient charts. So far, they hadn’t found any innocent mistakes.
    But what else was possible? Something unusual, and far more sinister than a mistake. “Human resource factors are being evaluated,” Lund’s July 10 letter assured the DOH. “Independent investigators are conducting interviews of involved staff.” 11

    O n July 14, attorney Raymond J. Fleming, of the law firm of Sachs, Maitlin, Fleming, Greene, Marotte and Mullen of West Orange, drove out to Somerset Medical Center. Fleming was briefed on the situation by Mary Lund, then set up in a room to meet with Charles Cullen. 12
    Charlie found Fleming seated at a conference table wearing the telltale dark-suit-bright-tie combination that distinguished corporate lawyers from undertakers. Charlie knew this had to be about the recent deaths on his ward; he’d been through this sort of thing plenty of times before. He was ready for the questions.
    Ray Fleming seemed to already know a bit about him. He knew that Charlie had worked at Somerset for less than a year, and that he had left jobs at many other hospitals in the past. To Charlie, that suggested that the man had looked at his application. Charlie hadn’t listed the proper dates there. Maybe this lawyer knew that, too. Maybe that mattered, maybe not. Charlie didn’t think it did. It never had before.
    Fleming also knew about the Reverend Gall. That seemed to be the point of the meeting. He knew, for example, that Cullen was not Gall’snurse the night the reverend died, but that Cullen had worked with him before, and that he was familiar with Gall’s medical history. Fleming knew that history, the medical issues Gall came in with, the time line of his illness and apparent recovery, and the spiking of his digoxin levels just prior to his code. He also knew that Charlie had been assigned to Reverend Gall for three nights, June 15 to 17.
    Charlie had ordered digoxin for Gall on his first night, the fifteenth. He’d then canceled the order. It was on his Pyxis. Charlie was also working on the night Gall died. On that night Charlie had again ordered, then canceled, digoxin. It was one of his two cancellations that night.
    Neither of these cancellations made much sense as mistakes—if Charlie had typed in the wrong code, or pressed the wrong button, then you’d expect the mistake would be immediately followed up with another, presumably correct, drug order. The Pyxis orders were time coded. There had been no immediate follow-up orders. Apparently, Charlie had typed in his name, the patient, and the drug on the keypad, only to suddenly realize, as the drawer popped open, that he needed nothing from the machine, at which point he’d simply cancel the order and walk away. It was a bizarre scenario.
    Fleming had another interesting fact at his disposal. He’d checked with the pharmacy and discovered that a number of vials of dig had been unaccounted for that month. Fleming didn’t put any of this in a particular order as far as Charlie could tell, and he didn’t accuse Charlie or threaten him or offer to let him resign, as other interviewers had done before. It was a curious interview, Charlie had to admit, and it got stranger when Fleming asked him a question:
    Was Charlie aware that if he ordered a drug, and then canceled the order, that the cancellation still showed up on his computerized Pyxis record?
    “Yes,” Charlie told the lawyer. If he didn’t know it before, he certainly did now.

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    C harlie was pretty certain they were just looking at his digoxin, as if dig was somehow the problem. But the night before Fleming’s interview, Charlie had