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

so-called terminalexperiments tapered at death. It’s the ultimate outcome for every insulin overdose of sufficient volume.
    But the use of intentional insulin overdose had its origins as therapy. The intentional induction of a coma, or shock, was considered the ultimate sobering slap for certain maladies of mind, a treatment started in Switzerland soon after the discovery of the hormone in the 1920s. Like electroshock, insulin shock therapy was used throughout the 1950s in the treatment of paranoid schizophrenia, before being discontinued due to the violence and occasional brain damage that were the occasional side effects of the brain-starving procedure.
    Surviving an insulin coma is like surviving a near drowning, and the extent and permanence of the injuries are related to the length of time that the brain was starved of nutrient. Continued starvation damages the cerebral cortex. The microscopic chemical architecture of the brain collapses, the surface area smoothes, and crenulations simplify, much like the brains of patients with neurodegenerative disorders. The effects range from Parkinson’s-like symptoms of rigidity and the choreiform, or jerky, movements of a damaged motor cortex, all the way to permanent intellectual retardation.
    But of course, the ultimate effect was death. The only trick was figuring the right dosage.

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    C harlie always preferred the hospital at night, without extras: the candy stripers, administrators, and visitors. The gift shop was closed, the public bathrooms locked. Even the janitors were gone, their whirring machines lassoed with yellow extension cord.
    Overhead, the mercury vapor lights hummed like neon. The vending machines murmured down the empty hall. The break room tables showcased teeth-marked Styrofoam cups, lipsticked bendy straws, still lifes with Snack Mix and mini-donuts. Some of the other nurses ate this crap all night, but not Charlie. Charlie never ate on shift. He waited.
    He watched the silhouettes through the Levolors, waiting for the small hours. Then he waited on Mr. Strickland. He checked his chart on the Cerner, made coffee, checked again. He was still there. Charlie always made the coffee. Some people were so inconsiderate about that; they used the coffee but they never refilled it, which was okay, but he was always taking care of it, helpful in that way, secretly helpful. He watched the nurses at the station, stirring their coffees, his coffee, helped by what he did, dependent really but not even knowing it.
    He pulled a 10 cc syringe from his scrubs pocket and injected four ampoules of insulin into the port of Mr. Strickland’s IV, throwing the syringe and ampoules in the sharps bin. Then he signed out and went home. He never saw Mr. Strickland go through his convulsions, but he had the commute to imagine.
    He arrived early the next day, still September 22. Charlie walked quickly by Stickland’s room and glanced in. The man, or someone, was still in the bed. In the hall he checked the chart, using the mobile Cerner, staying away from the nursing station and the chitty chat. It was 7:05, only minutes intohis shift, but he couldn’t wait. He wheeled the cart back to the nurses’ station for the shift change.
    Charlie sometimes had no patience for these details, but he did today. The day nurses colored in the details of the numbers Charlie had seen on Strickland’s Cerner screen.
    Mr. Strickland’s blood sugar had been routinely tested that morning. The lab had found zero glucose in the sample, and assumed there had been an error. A man couldn’t survive on zero blood sugar. They did not imagine that Strickland had already been hypoglycemic for over three hours. As the morning wore on, Strickland’s sugar-starved brain began eating itself.
    Strickland’s daughter arrived midday, this time with her older, teenage son. Charlie had seen the boy before and generally tried to avoid him during visiting hours. Apparently, it was he who first noticed something wrong