A Literary Thriller with Legs

Skepticism seems to be a natural by-product of literary nonfiction. Today, in the wake of James Frey and Stephen Glass, we tend to think of ourselves as uniquely cynical, in possession of more highly calibrated bullshit detectors than our predecessors. But even back in 1966 when In Cold Blood appeared, savvy critics were quick to point out Truman Capote’s inconsistencies and flights of fancy. “I know fakery when I see it,” true crime writer Jack Olsen once said of Capote’s classic. Perhaps the main difference between then and now is not one of discrimination then but of tolerance. As Olsen said in the 1998/1999 edition of Point No Point, In Cold Blood’s whistleblowers didn’t make waves back when it came out because it was “such a superbly written book, nobody wanted to hear about it.”

When it comes to nonfiction, modern readers often seem less concerned with artfulness than authenticity. These days we hold even humorists like David Sedaris up to close scrutiny, as if our amusement were contingent on a full accounting of the facts. This puts a heavy burden on writers aiming to do what the so-called New Journalists set out to do: use novelistic devices (dramatic scenes, dialogue, and the details of the environment) to breathe life into a story.

It’s obvious from the first page of journalist Charles Graeber’s new true crime book, The Good Nurse, that he is practicing in the tradition of New Journalism heavyweights like Gay Talese and Capote. The introduction’s close third-person point-of-view and unapologetically lyrical description of New Jersey’s highway system signals immediately that this book was not intended for the mass market shelf at Wal-Mart (though it’s engrossing enough to find a place there). What’s less obvious is the clever way in which Graeber has chosen to short circuit our suspicions about the veracity of what he’s telling us. On its face, The Good Nurse is a tense, starkly drawn history of the grim life of Charles Cullen, the New Jersey nurse now thought to be the world’s most prolific serial killer. But from a purely journalistic standpoint, it also an interesting exercise in accountability.

It took Graeber nearly seven years to report Cullen’s story and it’s not hard to see why. For almost two decades Cullen used his access to drugs and his privileged position as a nurse at hospitals across New Jersey and Pennsylvania to engineer the deaths of as many as 400 patients. Using IVs spiked with lethal amounts of insulin and a range of other deadly drug cocktails, he targeted a seemingly random group of victims that included the young and old, male and female, sick and recovering. Even as evidence of his misdeeds mounted, he was allowed to move between hospitals with relative impunity, his crimes so hard to prove that it took the small team of New Jersey detectives who ultimately brought him down months to piece together a case for prosecution. Accurately presenting a case as bogged down in bureaucracy and misinformation as this one would be a daunting task for a straight crime reporter. The task becomes even more complicated for a writer interested in creating a taut, compelling narrative that shines a light on the warped psychology of its central figure.

It would have been easy for this book to get mired in the minutiae of medical jargon and legalese, but it never does. Graeber accomplishes this by keeping a tight rein on his story. The Good Nurse is meticulously crafted. Events are ordered in a manner that builds tension; richly descriptive scenes and Elmore Leonard-esque stretches of dialogue are skillfully deployed to lend the story a sense of immediacy. Perhaps most importantly, Graeber keeps the book from feeling bloated by making careful decisions about what to leave out. All of these choices combine to make The Good Nurse read more like a Gillian Flynn novel than a piece of reporting, which inevitably brings up questions for the reader.

In Chapter 4, when Graeber offers a harrowing moment-by-moment account of a patient who “coded” in 1991 after being hooked up to one of Cullen’s poisoned IVs, it’s hard not to wonder how a scene like this could be faithfully reconstructed after so many years. In Chapter 34, when he relates a particularly damning conversation between detectives and a lawyer representing Somerset Medical Center about the hospital’s investigations into Cullen, the questions crop up again. How could Graeber have access to this level of detail, we wonder? How can he know so much about what Cullen is thinking? Instead of relying on our good faith as many literary nonfiction writers have done, Graeber addresses these questions head on by creating an exhaustive endnotes section. In it he details his sources, offers insight into his reporting techniques and provides additional background material. Graeber, in effect, fact checks himself. In the endnotes, we learn that the scene with the coding patient was recreated using details provided in “police report investigations, witness statements, and court documents, in addition to interviews with Charles Cullen and Thomas Arnold [Saint Barnabas Medical Center’s internal investigator].” And we are told that the dialogue from Chapter 34 was pieced together using police investigation documents and the recollections of detectives.

Certainly other nonfiction writers have employed endnotes before, but I’ve never seen them used in quite this manner. With his endnotes, Graeber seems to be intentionally putting his own reporting process under the microscope, demonstrating the exact nature and extent of the liberties he has taken in relating Cullen’s story and providing additional material excised from the main narrative for the sake of clarity and momentum. The endnotes are so comprehensive they may, in fact, feel like overkill to certain readers. (In one instance, Graeber devotes nearly a hundred words to explicating a throwaway reference to Saint Barnabas.) But this is the beauty of endnotes. You don’t have to read them. And by showing us how the intellectual sausage is made Graeber has accomplished something remarkable: he’s allowed himself the freedom to construct the main narrative for maximum impact while never jeopardizing our trust. The end result is a book that demonstrates the transportive power of literary journalism while simultaneously helping to restore its credibility.