The Good Nurse: A True Story of Medicine, Madness, and Murder

Personal and institutional silences allow Charlie to continue his crimes for 14 years. He thrives because too few people are willing to be disruptive enough to stop his activities. Repeatedly, the biography shows a pattern in which he’s detected but unpunished, a perpetuation that encourages Charlie because of how easily he can get away with it. However, the few times that people speak up against Charlie not only prevent him from killing patients but also propel investigations against him, all of which contribute to his ultimate arrest and conviction. This applies in broader situations, because the actions of a few, important individuals show the importance of speaking up.

Among those who speak up and thus hamper Charlie’s machinations are the nurses at Sacred Heart Hospital. It’s Charlie’s second-to-last hospital and his shortest employment, as he’s fired within two weeks. His termination stems directly from a nurse who associates him with a prior patient death, in which his involvement is suspected. Because she speaks out against his presence and rallies other nurses around her, she protects patients at her hospital from his crimes. However, she’s the only nurse to risk her own termination to ensure that Charlie is kept away, and she’s the only person to actively organize against his presence. She shows how powerful an individual’s actions can be, especially within the context of a broader injustice or worry.

Similarly, Amy speaks up against Charlie. Although she does so in a much more private context, her action is no less important than those of the nurses who publicly protest Charlie. When she tells Danny about her concerns, he quickly validates them by looping her into what they know and suspect about Charlie. Despite her confusion and guilt, she aids the police, speaking up about patterns she sees in the evidence and proving them through vital institutional knowledge that helps shape the case. Her choice to do so despite her internal feelings underscores how speaking up against an injustice or concern isn’t always easy; in fact, it often contradicts other moral considerations such as loyalty, making it important to pick the “most right” option. Tim reinforces this when he, as a private citizen, reaches out to Montgomery Hospital to warn them about Charlie. In doing so, he also alerts the media and puts the investigation on a tight timeline to make an arrest before Charlie flees. Despite the significant consequences of his action and the pressure it causes, Tim successfully waylays Charlie and saves lives through his decision to advocate for the vulnerable.

In this instance, silence is as telling as speaking up. Charlie’s history is rife with people, both in positions of power and in positions of vulnerability, who don’t speak out against him. This often reveals a greater interest in gain than in patient safety and security: Hospital administrators at for-profit institutions are primarily concerned with profit. By explicitly listing the many ways that Charlie was fired without formally getting a mark against him, and by highlighting those who spoke out on behalf of patients, Graeber reinforces the negative impact of inaction and the direct positive impact of advocating for justice.

Charlie practices nursing within the context of a for-profit healthcare society, a system that often emphasizes profit over patients’ well-being. This money-focused perspective then creates a cycle of cutting corners and minimizing concerns. Institutions become more concerned with their “brand” than with the services they provide. Charlie’s many different interactions with healthcare institutions across two different states highlight the fallibility of institutions. Repeatedly, mistakes are made or even perpetuated to hide wrongdoing.

One of the first repeated motifs evident in these institutions is their hiring mistakes, central to which is their lack of appropriate full-time staff. Charlie repeatedly and quickly finds employment because so few institutions have the people they need to function effectively. High demands for staff make Charlie an attractive candidate, both because of his work experience in multiple hospitals and his willingness to pick up extra shifts. This apparent helpfulness expedites his being hired. Hospitals become accepting of neutral references and don’t pursue formal recommendations for Charlie and his work. In addition, they often fail to run background checks, which hides Charlie’s criminal record. Charlie exploits this need for staff and moves from hospital to hospital, only hindered on the rare occasions when people speak out against him.

Another way that institutions fail is by not trying to provide Charlie with the help and support he needed in his early life. He repeatedly interacts with institutions that should try to help alleviate his physical and emotional struggles. After losing his mother and being unable to say goodbye to her because of an institutional mistake, he joins the Navy and receives abuse rather than support. He’s belittled and is the butt of jokes, always being treated as an inferior. When he experiences alcoholism and attempts to die by suicide several times, the very entity that should take care of him instead disregards him—and when he’s institutionalized, he’s released without a formal exit plan or care plan in place. He re-enters society with no more support than he had in the first place, creating a cycle in which he believes that no one and nothing cares for him. This contributes to his murder streak because he visualizes himself as a victim whom the systems around him have failed—and in some ways he’s correct: With more support, therapy, or medication, Charlie’s negative ideas and actions might not have escalated as dramatically.

Yet another institutional failure is that of the police, as Tim and Danny’s experiences reveal. Tim bears the brunt of one of the largest failures because systemic corruption uproots one of his investigations. It takes years for him to feel absolved of the guilt of not being able to formally solve the case despite having vital evidence to identify the culprit. The struggles within the police system expand further as Tim and Danny try to seek resources to solve the hospital overdoses but are repeatedly prevented from accessing resources by people who would rather receive credit and praise. On several occasions, the systems restrict their actions so much that they must take matters into their own hands, an action that is both occupationally and personally dangerous.

These repeated mistakes and failures clearly outline the need for systemic checks and balances to ensure the safety and well-being of the people who interact with these systems. At the book’s end, Graeber references two attempts to secure the healthcare system from enabling future nurses like Charlie, but these small steps reinforce the importance of paying attention to institutions and the areas they impact. Only by paying attention can people identify and correct problems.