The Good Nurse true story: Fact vs. fiction in Netflix movie about Charles Cullen.

Netflix's The Good Nurse tells the story of how serial killer Charles Cullen was able to abuse his position as a medical worker to murder patients at a succession of hospitals while he remained protected by institutions that were more threatened by possible lawsuits than unnecessary patient deaths. Directed by The Investigation and A War filmmaker Tobias Lindholm, written by 1917 screenwriter Krysty Wilson-Cairns, and based on journalist Charles Graeber's book of the same name, it also stars Eddie Redmayne and Jessica Chastain as the world's most improbably good-looking (even with unflattering normie haircuts) ICU nurses.

Chastain portrays Amy Loughren, an overworked nurse at Somerset Medical Center's intensive care unit in New Jersey who is delighted when Cullen (Redmayne) arrives to help share the load, and the two bond in the quiet isolation of the graveyard shift. Cullen starts giving Loughren rides home and entertains her two young daughters, but after the police start investigating a spate of ICU patient deaths at the hospital, her suspicions are roused. Loughren eventually provides the police with the information they need to arrest Cullen and is instrumental in getting her colleague to confess to at least some of the deaths he was responsible for. Cullen eventually pleaded guilty to murdering 13 patients and to the attempted murder of two others. He was convicted of being responsible for the deaths of 29 people, though authorities believe he may have killed as many as 400, a number that would make him the deadliest serial killer in American history.

How was Cullen able to keep poisoning patients for more than eight years at nine hospitals without facing justice? Did Loughren really discover what others could not? And what drove Cullen to do it? We consulted multiple books and several news articles about Cullen's murders to break down what's ripped from the headlines and what's artistic license.

In the film, Loughren and Cullen become very close. She invites Cullen over for dinner, where he reads stories to her two young daughters and helps one rehearse for a play. He also tells her of his troubles with his ex-wife, who won't let him see their daughters. Loughren, meanwhile, tells him her secret—she has cardiomyopathy and needs a heart transplant. She should be resting instead of working but can't let the hospital know about her illness because she has four months before her employment-related health insurance kicks in, and since the respiratory problems caused by her illness make her too weak to turn patients and prone to fainting, she might get suspended or fired if the news gets out. Cullen promises to help her through the illness and purloins some medicine for her from the ICU's computerized dispensary. Later, when her suspicions are roused, she is aware that if she turns him in, he could reveal the secret of her illness.

Author Emily Webb, who wrote about the case in Angels of Death, her book on homicidal medical professionals, found no evidence that Loughren ever invited him over to her family home or indeed that he ever met her daughters. (In real life, Loughren's daughter Alex was 11, while the movie portrays her as closer in age to Cullen's younger children.) Still, she and Cullen were definitely good friends. "He was funny," Loughren told People. "We bonded right away." The film's depiction of Loughren's conflicted emotions over wearing a wire to meet her friend at a restaurant in the hope of getting him to confess is also real. "I was wrestling with how much I still cared for him. He was my friend. I didn't know the murderer," she recalled.

Webb's book also contends that while Loughren did have cardiomyopathy and kept it secret from her employers, her disease was not that advanced and could be treated with a pacemaker and medication, so she was never on the transplant list. Moreover, Webb does not refer to Loughren being concerned about health insurance but asserts that she concealed her illness primarily because she didn't want to lose her job with its good salary and a $1,700 per month housing stipend. According to Graeber, the job was "the best Amy had held in nearly fifteen years of nursing."

Cullen's ex-wife, Adrienne Taub, did try to stop him from seeing his daughters, but the film omits why, suggesting it was just part of a nasty divorce. In reality, Taub contacted the police in January 1993 telling them that she was afraid of her husband, and filed for a restraining order, claiming he had burned her daughter's books and abused the family's Yorkshire terriers. Cullen denied these claims, but Taub was granted her restraining order.

Redmayne plays Cullen as a bit shy and reserved but considerate and empathetic—not qualities usually associated with serial killers—and attractive enough that there is a hint of romance in his interactions with Loughren.

However, according to Webb, neighbors who knew Cullen as a child described him as socially inept and odd, relentlessly teased and picked on by other children, to the point where Cullen survived his first suicide attempt at age 9. Cullen was as much of an outsider after he joined the Navy and was assigned to a nuclear submarine, the Woodrow Wilson. New crew members had to go through an informal hazing ritual where the experienced sailors found the newbies’ weak points and pounded on them. "They had that honed on Wilson to a fine art," John M. Darnielle, a crewmate of Cullen's (and no apparent relation to the singer and novelist), told the New York Times. But even the other new recruits felt free to insult Cullen. "In an environment devoid of many entertainments, these guys would make their own by messing with Charlie," Darnielle said.

Pleasant Maynard-Klemka, who lived next door to Cullen when the nurse lived alone after getting divorced, recalled, "When he didn't think you were looking, he’d make weird faces, like he was real angry or thinking really serious." During this period, he reportedly had no friends. "None at all."

In the film, as Loughren becomes more convinced that her friend is at the very least stealing drugs from the ICU dispensary and starts to put up boundaries, there is a suggestion that she is afraid he will have trouble respecting those boundaries, but he does not do anything untoward. In real life, shortly after his divorce in 1993, Cullen took a nurse he worked with at Warren Hospital* on a date and then started bombarding her with phone calls, culminating in a proposal to her at work. He was finally cited for criminal trespass after he broke into her home as she and her young son slept.

After the police show Loughren a report on the drugs Cullen has ordered from the dispensary, she realizes something is really wrong. When it becomes clear the hospital has no intention of assisting the police investigation, she gets in touch with an old friend who is a nurse at a hospital where Cullen used to work. The friend says that when Cullen was on the ward, there were two or three Code Blues (deaths or near-deaths) a night, but after he left there was only one a month. The nurse says she discovered Cullen put pinpricks in saline bags through which he injected insulin or a heart medicine called digoxin. However, the nurse isn't willing to go to the police to corroborate Loughren's suspicions because she's afraid she would lose her job.

In fact, several nurses at hospitals where Cullen had previously worked tried to alert the authorities. Seven nurses at St. Luke's Hospital in Pennsylvania persuaded the Pennsylvania State Police in August 2002 to come to the hospital after Cullen had taken up an offer to resign, later telling the Lehigh County district attorney's office that they suspected a former colleague had been found mishandling medication and might have been involved in the deaths of several patients. However, the resulting investigation was cursory and the case was dropped after eight months for lack of evidence.

In 1998, after an elderly patient with a suspected insulin overdose was rushed from a nursing home where Cullen worked, Kimberly Pepe, the nurse who had cared for the patient on the overnight shift, denied repeatedly that she had given the patient insulin. Instead, she asserted that Cullen, who was caring for another patient in the room, might have been responsible. At first, Pepe's supervisors agreed that Cullen was probably the guilty party, but then they changed their minds. After the patient died, the nursing home fired Pepe (although they later settled a lawsuit she brought on terms that remain undisclosed), while Cullen was kept on staff. The home never reported Cullen to either the police or Pennsylvania's State Board of Nursing.

Along with nurses, the relatives of at least three of Cullen's victims suspected foul play and tried to get the medical facility and/or the police to investigate, but faced stonewalling on the part of the hospitals and botched or less-than-thorough investigations on the part of law enforcement. It is thought that most of the victims’ families have received financial settlements that prohibit them from talking about the case, which may account for their lack of representation in the film. Certainly, in 2008, five hospitals settled wrongful-death lawsuits with the families of 22 victims, a negotiation that took four years. The suits alleged that hospital administrators did nothing to stop Cullen from using stolen medications to kill patients and failed to notify authorities about their suspicions. None of the hospitals admitted wrongdoing. "Eventually, you get worn down," said John Shanagher, the son of one of Cullen's murdered patients. "I would have liked someone to have stepped up, but I guess this is as close as we’re going to get."

However, it is true that Cullen only confessed because Loughren persuaded him at the police station to come clean about one of his crimes.

The film opens with a young Cullen being pushed to the side as a medical team urgently administers defibrillation to a family member. He later tells Loughren that his mother died in the hospital, where her body was lost and left to lie naked and forgotten. This possible desire to get revenge on hospitals is as close as the film comes to suggesting a motive.

In fact, although Cullen had the means (access to a supply of medicinal drugs), and the opportunity (being left unsupervised and unobserved with patients who were often semi-conscious or unable to speak), his motive remains obscure. He wasn't actually present when his mother died. She was killed in a car accident when he was 17, a devastating experience made worse by what he felt was the hospital's callous treatment of him, as they delayed notifying him of her death and cremated her body without asking if he’d like it returned. In the book on which The Good Nurse is based, Graeber writes, "Charlie felt that they’d lied to him at Mountainside Hospital, a crime he would come to believe was characteristic of hospitals in general, and one that he would never forgive."

Cullen himself has suggested an alternate motive. In his 2003 confession, Cullen represents himself as a kind and compassionate carer, believing he acted to end his patients’ suffering and was performing a community service by preventing hospital personnel from dehumanizing them. He reiterated this theme in a 60 Minutes interview. "I thought that people weren't suffering anymore. So, in a sense, I thought I was helping," he said. "You know, what I did, there is no justification. I just think that the only thing I can say is that I felt overwhelmed at the time." Cullen expressed remorse for his crimes but then added, "I don't know if I would have stopped."

Correction, Oct. 27, 2022: This article originally misidentified Warren Hospital as being in Pittsburgh. It was in Phillipsburg, New Jersey.