The True Story Behind ‘The Good Nurse’ Is Even Darker Than We Realized

Directed by Tobias Lindholm and adapted by Krysty Wilson-Cairns from the non-fiction book by journalist Charles Graeber, The Good Nurse focuses on real intensive care unit nurse Amy Loughren, played by Chastain, and her colleague Charles Cullen, played by Redmayne. They worked together at Somerset Medical Center — now called Robert Wood Johnson University Hospital Somerset — in Somerville, New Jersey.

As the film tells it, Loughren gradually becomes aware that Cullen isn’t the caring nurse she thought he was, as a picture emerges of patient deaths and murderous behavior. Through all this, however, Loughren and Cullen had a friendship, forged in the heat of the hospital night shift and its various pressures. The filmmakers wanted their relationship to be at the heart of the movie.

Those involved in the production wanted to tone down examinations of Cullen’s motives and to touch on the alleged institutional failings that led to him going undetected for so long. Speaking to Harper’s Bazaar, Jessica Chastain described the film as “a true story about how a woman stopped a cycle of violence with humanity and compassion, and by reminding someone that he was human when everyone else was treating him like a monster.” That said, the human side of Cullen isn’t used to muddy the moral waters. “Tobias doesn’t want to give him an excuse,” she later added.

The question is, though: is The Good Nurse a strong reflection of its subject matter, or does dramatic license win out? Well, let’s begin by looking at the life of Charles Cullen. Born in 1960, he was raised in the Essex County township of West Orange, New Jersey. One of eight children, he lost both parents during his younger years. Father Edmond passed away when Charles was seven months old. Mother Florence died in a car accident after an epilepsy attack in 1977.

Cullen was upset about how the hospital handled Florence’s death and its aftermath. He felt he could have been informed sooner. Also, Florence was cremated on site, which disturbed him. The young Charles then tried to take his own life. Some sources state he first did this as a teenager, though others say he tried when he was only nine.

Overall, Cullen didn’t talk fondly of his childhood, saying he was bullied. He would go on to be institutionalized for a period. Between 1978 and 1984, Cullen served in the U.S. Navy. Here, his bullying ordeals reportedly continued. Plus, his strange behavior was noted by superiors. It was clear he wasn’t going to thrive in this environment, which saw him dive beneath the waves.

In a foreshadowing of things to come, Cullen was reportedly disciplined for wearing surgeon’s garb on a submarine. There he sat at the missile control post, complete with mask and scrubs. This led to him being sent to work on a supply ship. He would later receive a medical discharge from the service. During his time with the Navy, Cullen attempted suicide again.

After the Navy, Cullen studied nursing at Mountainside Hospital in Montclair, New Jersey. His first job was at the burns unit of Saint Barnabas Medical Center in Livingston, Essex County. While all seemed well on the professional front, with Cullen entering nursing as president of his class, the situation at home was bad. From the outside, things may have seemed okay.

In 1987 Cullen began building a life with Adrienne Taub. The pair got married the same year. She gave birth to two daughters but, despite settling down, it seemed things were far from settled with Charles Cullen. Taub went on to claim her husband was mentally unstable and dangerous. He reportedly put lighter fluid in drinks to try and poison people.

Cullen also allegedly displayed cruel behavior toward the children and the family pets. A restraining order was then filed in 1993. Charles Cullen denied her accusations. The details of the couple’s turbulent marriage are not explored in the narrative of The Good Nurse. Cullen is shown as divorced and barred from seeing his children, but we aren’t told exactly why this is.

Meanwhile, Cullen was going into work and harboring his dark secrets. He murdered patients in cold blood by administering fatal drug overdoses. Disturbingly, he was able to carry out these crimes over a period of approximately 16 years. It isn’t known exactly how many people died at the hands of Charles Cullen, but the highest estimate is a staggering 400.

Cullen started committing the murders during his first job at Saint Barnabas Medical Center. Frighteningly, he would spike up to five IV bags per week. He didn’t target patients here — whoever got the bag died, in a gruesome lottery. Arguably the big difference between Cullen’s actual crimes and how they’re presented in The Good Nurse lies in the victims themselves.

Director Tobias Lindholm and screenwriter Krysty Wilson-Cairns chose to totally fictionalize the poor souls murdered by Cullen. The scale and the horror of the story is preserved, but the patients here are dramatic creations. Why was this key decision taken? As noted by Esquire, the filmmakers felt the families had suffered enough, without having their loved ones resurrected in a movie adaptation.

There was also the small matter of non-disclosure agreements (NDAs) apparently signed by the parties for Cullen’s employers. We’ll talk more about the fallout from Cullen and the medical industry’s actions a little later. All in all, Cullen worked at nine hospitals until justice finally caught up with him in 2003, when he joined the critical care unit at Somerset Medical Center.

Cullen met and formed a friendship with fellow nurse Amy Loughren. Reflecting on those times to The Guardian, Loughren said, “His knowledge of medications, his knowledge of critical care was outstanding.” She went on to add, “I’m drawn to people that are smarter than me.” It seems that Charles Cullen was someone who Loughren looked up to as a great colleague.

Behind the scenes, however, Cullen was going about his grisly business. As well as feelings of mutual trust you’d associate with professionals in this setting, Loughren came to rely on Cullen in other ways. She suffered from cardiomyopathy, an affliction of the heart’s muscles that can prevent the organ pumping blood around the body effectively. How did she cope with this and her demanding role?

It was something Loughren needed to keep under wraps, for fear her employers would let her go and she’d lose her insurance, according to some sources. Cullen kept her secret and would cover for her when she was overwhelmed. This is addressed in the film, though it appears some facts are altered. The Good Nurse depicts Amy Loughren as needing a heart transplant.

This appears to be an invention of the screenwriter. History vs. Hollywood mentions that Loughren actually managed the disease with medication and a pacemaker, an observation made by Emily Webb, author of the book Angels of Death. Apart from this dramatic addition, and the fact she’s played by a Hollywood actress, much remains the same, including family life with her two daughters.

Loughren was also a single working mother and, while the temptation is there to wonder about any attraction between her and Cullen, the close relationship they shared was purely platonic. Furthermore, The Good Nurse shows Cullen going to Loughren’s home and interacting with her children. It doesn’t appear to have been the case that they were familiar to this extent.

The focal point of the friendship was their place of work, the Medical Center. It was here, through Cullen’s terrible deeds, that over a dozen people are thought to have lost their lives. One exception was patient Philip Gregor. He had a lucky escape when Cullen’s usual method of dispatch failed, and he got to live out the remaining few months of his life.

Somerset Medical Center was a place where too many people were dying, a fact which simply couldn’t be ignored. How long did it take for this appalling situation to be acknowledged by authorities? When did the police become involved? How did Amy Loughren come to realize that Charles Cullen was a mass murderer? The potentially explosive details can change, depending on which sources you read.

Naturally The Good Nurse has its own approach to the real-life material. While it’s not a heavily fictionalized account, with participants such as Amy Loughren herself consulted over the production, it is a piece of thought-provoking entertainment. What does it get right about the build-up to Charles Cullen’s arrest? The movie puts Jessica Chastain’s Loughren at the core of the drama.

The fictional Parkfield Memorial Hospital takes the place of Somerset Medical Center. The death of an elderly patient results in police being alerted by the administration board, though investigators are met with a muddled and suspicious-looking picture when they start examining events. Detectives Danny Baldwin and Tim Braun, real-life figures played by Nnamdi Asomugha and Noah Emmerich respectively, are assigned.

Baldwin is depicted as suspecting Cullen from an early stage. After things get heated between Baldwin and risk manager Linda Garran, a fictional character played by Kim Dickens who is allegedly based on Somerset’s Mary Lund, the police are shut out of the institution. Met with an uncooperative response from Cullen’s former employers, the chances of catching the killer look slim.

Eventually, Baldwin and Braun involve Amy Loughren as an active participant in their investigation. They’d questioned her previously when suspicions were first raised, though Loughren defended Cullen as a professional. She’d gone on to do her own detective work, speaking to a former colleague of Cullen’s who lifted the lid on previous deaths on his watch. The penny finally drops for a shocked Loughren.

Should Amy Loughren have identified something odd sooner? Did her busy schedule and its accompanying pressures allow her to? In her interview with The Guardian, she talked about what happens on a busy ward. Split-second decisions are made, based on a deep level of trust. She wouldn’t probe a colleague “when you know that they’re a very skilled nurse.”

With regards to challenging a decision that a colleague might make, even if it appears strange, she says, “They’re a good nurse, they have their reasons.” Loughren saw Cullen as a good nurse. However, it wasn’t long before he was unmasked as the “Angel of Death.” Evidence presented to her made the realization inevitable. As everything unfolded, Cullen was dismissed from his job.

That didn’t mean he was banged to rights, of course. Detectives still needed a smoking gun. In the film, Loughren agrees to meet Cullen for a supposedly social meeting, at Baldwin and Braun’s urging. They then make their move to arrest Cullen, however, a confession is not forthcoming. It’s left to Loughren to have a final heart-to-heart with her friend.

It’s here that he reveals his true nature as a prolific killer. Broadly speaking, the sweep of the case is captured accurately by the movie. Institutions did allegedly create obstacles and the detectives required Loughren’s help to bring Cullen to justice. The friendly exchange she shared with him in custody did happen. As revealed at the film’s end, Cullen was given 18 consecutive life sentences.

Cullen reportedly pled guilty to 13 murders and the attempted murder of two patients. He was convicted for 29 killings in total. Away from the screen version and back in real life, Cullen avoided the death penalty via a plea deal through which he would cooperate with authorities. Cullen is now known as the most prolific murderer in the history of New Jersey.

Amy Loughren coped with the fallout from her friend’s crimes as philosophically as she could. “I didn’t really meet the murderer,” she told The Guardian. Cullen was close to her but he also concealed what he was doing very effectively. “My integrity is pretty damn intact,” Loughren says. It wasn’t her responsibility alone to catch this calculating criminal, after all.

The Good Nurse can be said to narrow its scope somewhat by concentrating on Loughren’s experience. Understandably, it condenses these events to fit the framework of a two-hour film. Yet in reality, she wasn’t the only medical professional to notice that something wasn’t right. As noted by Slate, one former colleague named Kimberly Pepe paid the price for Cullen’s crimes.

Back in the late 1990s Pepe reportedly lost her job at a nursing home when a patient died from an insulin overdose and she pointed the finger at Cullen. He used insulin and particularly the drug Digoxin to murder his victims. Then, in the year before his arrest, staff at St Luke’s in Pennsylvania raised the alarm.

An investigation lasted eight months but didn’t get anywhere. By this time Cullen had moved on. Relatives of the deceased were also suspicious but their concerns appear to have been ignored. The facts behind any deals done between the individuals involved and the institutions is something that remains mysterious, leaving threads which dangle frustratingly two decades on from the arrest.

The makers of The Good Nurse saw it as their duty to highlight failings in the system, yet they can only suggest so much. How far can these factors be used to throw light on what drove Cullen to kill? Stories emerged that Cullen was committing his awful acts out of mercy for the victim. There was also another, stranger, layer added to the story.

Cullen seemed to equate the hospitals’ allegedly negligent behavior with his own actions. By allowing him to proceed with his murders and getting rid of him rather than prosecuting him, Cullen viewed them as hypocrites. As such, by becoming a mass murderer, he was commenting on these supposedly broken administrations. Author Charles Graeber’s opinion on Charles Cullen is relatively straightforward.

Graeber’s true crime book The Good Nurse was released in 2013. As someone who has spoken to Cullen himself, he isn’t swayed by any personal justifications that Cullen may have. Speaking to Newsweek, Graeber says his behavior “had everything to do with what he needed at that moment and what worked for him, and absolutely nothing to do with those people.”

Cullen seemingly isn’t someone who showed mercy, or much interest in exposing the issues behind the private healthcare system. Cullen comes across, both in the film and from real-life accounts, as someone who is deeply disturbed, and who has gone down a dark and despicable path. Yet he did have a human side, as Amy Loughren learned. Did she see him after he was jailed?

There was a meeting behind bars, though this was before Cullen knew of the role she’d played in his arrest. The pair reportedly haven’t spoken since, which must leave both with a strange feeling. Amy Loughren can at least be proud of what she did in tackling Cullen and making sure he couldn’t harm anyone again.