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

killed a man with dobutamine, 1 a chemical relative of adrenaline. It worked fine.

    H is shift hadn’t started yet, but Charlie was already in his whites when he walked into James Strickland’s room to watch him breathe. Then Charlie felt a presence, someone at the door behind him. He tucked the sheet, as if finishing up nurse work, then ducked toward the door.
    “Charles?” It was Mr. Strickland’s daughter Janece, a middle-aged blonde woman with an oversized purse denting her shoulder. The daughter noticed things, used his name, asked questions. It was uncomfortable for Charlie, like walking too close to a strange dog on the street.
    He’d seen her several times during her visits to her father. They’d interacted and, gradually, fallen into roles Charlie was more comfortable with. He liked to explain the technical aspects of her father’s medical condition, and she seemed to listen. She also sometimes brought her younger son along, an autistic boy, a child Charlie thought of as vulnerable, though tonight, she was alone.
    “Charles?” the woman said again. “Charles, are you my father’s nurse tonight?”
    Charlie didn’t want to talk. He kept moving, pretending he hadn’t heard as he turned down the hall into another room and waited until the daughter left. Then Charlie pulled the Cerner cart to the end of the hallway and called up Mr. Stickland’s charts. No, he wasn’t Mr. Strickland’s nurse,not technically. He shouldn’t even have been in Strickland’s room. But Mr. Stickland was still within Charlie’s sphere, and he had decided. Insulin.
    Unlike digoxin, insulin was a hormone, a drug the human body produced naturally. In the hospital, it dripped into the patient from an IV. In the body, it dripped from the pink waterlogged pinkie of the pancreas, radiating from special cells the textbooks called the islets of Langerhans. The name made it sound like it came from pirates. When Charlie was in nursing school, the foreign insulin, the drug diabetics used, all came from animals, pigs or cows, usually, as if it were a by-product of hot dogs. They’d all laughed about that in class, letting out a collective eew after they’d been so tough about so much else.
    Insulin was like a volume control for sugar. Not enough and you were diabetic. Too much and you were hypoglycemic. It wasn’t a poison—you can’t eat insulin and get sick; the stomach juices would gobble the bonds like hamburger. But injected overdoses happened, sometimes on purpose.
    First the lips and fingers go tingly and numb, then it’s the brain. The flood of insulin gives orders to the cells, makes them hungry. The cells take up the glucose; the blood is left barren and the extremities starve. The human brain, surviving on oxygen and sugar alone, begins to shut down, resulting in a confused stupor that occasionally lands hypoglycemics in the drunk tank by mistake. It’s a space-out, a fuzziness. The body goes insubstantial, the personality light, and individuals become either cranky or giddy, depending on their nature. Then the stomach sinks. Sweat beads form on the scalp. The head pounds, the heart skips, concentration evaporates. Vision slurs and pixilates. Moments pass, unfiled in memory.
    All this happens quickly. With a patient who is unwell, or already zonked on a tranquilizer or paralytic agent, these intellectual and perceptual effects may go unnoticed by the outside observer. The next stages will not.
    Insulin overdose is like a chemically induced drowning. The brain is literally strangled; the pupils dilate, then clench shut and refuse the light entirely. The movement of glucose triggers a sympathetic cascade of ions across the cell membranes. And then the convulsions start. 2
    Some of the most extensive research on insulin overdose was undertaken by Nazi scientists. At some concentration camps, children were injected with graduated doses of insulin to measure their endurance to extreme hypoglycemia. 3 The bell curve on these