Charles Graeber

I’m not a fan of true crime graphic murder podcasts or books. I can’t handle the gore. This nonfiction book tells the terrifying story of the prolific serial killer who killed by injecting drugs into the IV bags of his patient, but it’s not gruesome. It’s incredibly well-written and hard to put down. Excellent journalism, researched but not overwhelmed by facts. The author tells the story more in the style of In Cold Blood, connecting you to the people involved.

There are a lot of exciting advances in medicine, but surely none are as exciting and game changing as cancer immunotherapy. (Perhaps I am a little biased though having seen these treatments in action). Immunotherapy is not chemotherapy, but utilises new research breakthroughs to help allow the immune system to see cancer as something foreign and fight it. Unfortunately, it won’t help every cancer (some look more like foreign monsters to the immune system, others look like something show more normal) but immunotherapy and future breakthroughs in the field are going to be talked about for a long time. This book is timely because cancer therapy is no longer cut, burn and poison (surgery, radiation therapy and chemotherapy). As I’ve heard one person tell another, ‘I’m not on chemotherapy, I’m on immunotherapy’. Soon they won’t even have to emphasise that word as immunotherapies are being used more and more in various cancers. It’s given life extending options to people with melanoma (a deadly form of skin cancer), kidney cancer and lung cancer. For some patients, questions have been more about if and when immunotherapy should be stopped rather than how long they are going to live. It is early days though and by no means is immunotherapy the cancer panacea for all cancers.

Charles Graeber mixes patient experiences with various cancers that have been changed by immunotherapy and detailing the history of immunotherapy from William Coley’s experiments with bacteria and sarcoma to the discovery of CTLA and PD-1/PD-L1. Like other ground-breaking research, cancer immunotherapy hasn’t always been the coolest kid on the block. Graeber explains in detail the many failures and tiny steps forward that occurred before the latest breakthrough. It makes for fascinating reading. He also explains how the immune system operates very well and simply. My knowledge on reading this book has become much more detailed and because of it, my interest in immunotherapy has skyrocketed. (Just ask anyone who has spoken to me recently– I’ve been talking about immunotherapy all week). If you don’t know anything about B cells and T cells, it might be worth a quick refresher via the internet before you jump in.

One of the problems with talking about a field that is moving forward in leaps and bounds is that further breakthroughs will occur during the writing. Most of the recent discussion in this book is about CTLA-4 and the drug that acts on it (ipilimumab). PD-1 and PD-L1 (nivolumab, pembrolizumab, durvalumab atezolizumab and avelumab) don’t get quite as much page time – maybe that should be the sequel?! CAR-T cells – or T cells engineered to target cancer cells also gets a nice summary too (important as this is going to be used more and more in Australia). But overall, this is a great book to whet your appetite for what’s happening in cancer therapies these days. It’s clearly written, has the human touch and explains the technology in a way the non-medical person can understand. Those in healthcare will find it just as interesting (plus there are many references to scientific papers to keep you very busy).

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The Good Nurse is a chilling true crime story revealing the murderous sixteen year career of registered nurse Charlie Cullen, arrested in 2003 and eventually confessing to the murder of forty patients but suspected as being responsible for as many as three hundred.

Unlike ‘Angel of Mercy’ killers, whose twisted thinking means they think they are helping ease suffering, Cullen’s motivation for the murders were frightening in their lack of discrimination. He chose patients to murder based show more on random criteria irrespective of their ability to recover, injected drugs into anonymous IV bag’s, and made deliberate medication errors, unmindful of his victim’s lives.

Psychiatrists eventually ascribed Cullen’s actions to his need to compensate for his feelings of powerlessness. Graeber shares enough of Cullen’s personal history to give an idea of where his pathology was rooted though I got the impression there were deliberate gaps in his childhood experiences. As Graeber admits Cullen wasn’t very forthcoming in speaking about his life, this is understandable. Cullen’s ex-wife’s cooperation with the author revealed little other than his state of mind during the early years of his murderous sixteen year career.

The second half of the book concentrates on the police inquiry into Cullen. The research seems thorough in regards to the tracing of Cullen’s work history, the murders he was and may have been responsible for and the details of the police investigation. The difficulties in proving Cullen’s culpability are clearly explained, including the negligence of the hospitals who employed Cullen.

The book is also an indictment of a health care system motivated by profit, where lawyers make decisions not based on best practice but with corporate indifference. I was sickened no less by the actions of those that permitted Cullen to continue his spree, than I was by Cullen himself. Though unfortunately none of the various hospital administrators could be held criminally liable for their complicity in Cullen’s crimes, I was pleased that some of the families were at least able to enact civil penalties.

A disturbing yet fascinating read, The Good Nurse is the story of a frightening sociopath, a negligent and corrupt health care system and the tireless work of those who attempted to bring them both to account for their crimes. show less

Charlie Cullen is a complex being, and after reading this account of his life, you are likely to be left with more questions than answers. Why he did what he did can only be speculated and no one – not even Cullen himself - can give definitive answers. But as we learn more about Cullen and the hospitals and other care centers where he worked, we get a clearer picture of how these atrocities, random murders, could occur. This nonfiction book will enthrall and repulse you as you realize that show more it is possible that such murders could still be committed by the very people we trust to save lives. Well researched and written by author Charles Graeber, this is a story you won’t be able to put down until you’ve read it or forget it once you do. show less