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60 pages 2 hours read

Charles Graeber

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

Charles GraeberNonfiction | Biography | Adult | Published in 2013

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Part 2, Chapters 39-44Chapter Summaries & Analyses

Chapter 39 Summary

Om October 21, 2003, Charlie gives two patients an overdose of Xanax before returning to the apartment he shares with his girlfriend, Cathy, and her children. Their relationship grows increasingly strained. At work, Charlie starts to abuse the Pyxis machine by using it to individually order every single drug he needs, including Tylenol. Another patient overdoses on digoxin, but despite Charlie’s excessive drug orders, they don’t find the drug in his record.

Chapter 40 Summary

Danny, Paul, and a private detective meet at Saint Michael’s Hospital to hear a review of the six patient files Danny gave the examiner. The examiner confirms that the patients were given drugs from an outside source. Tim and Danny witness Reverend Gall’s exhumation and then meet with the medical examiner to observe the sample collection process.

Chapter 41 Summary

Charlie drives to work, reflecting on the vast economic differences between his home and his place of employment. He’s pulled over by a police officer who claims that his car is being impounded. The officer is kind and acquiesces to Charlie’s protests, offering to drive him to work while he gets the problem sorted out. Mollified, Charlie agrees and soon receives a call confirming that the impound was a mistake. That night, he’s terminated from Somerset.

Chapter 42 Summary

Amy takes the news about Charlie’s firing hard, calling him that night. Charlie claims that he was fired because of inconsistencies in his dates of employment on his job application. He claims that he was a scapegoat for Reverend Gall’s death and then mentions an investigation at St. Luke’s. Amy tries to comfort him, although she doesn’t understand the supposed reasons for his termination.

Chapter 43 Summary

Tim reflects on Charlie’s troubled personal and professional history, feeling frustration that they don’t have the necessary evidence to make an arrest. In reflecting, Tim reveals that the “impoundment” was actually a cover-up for putting a tracker on Charlie’s car. Despite their evidence supporting Reverend Gall’s murder and Mrs. Han’s attempted murder, they have no definitive proof of Charlie’s blame. Tim calls the Pyxis manufacturer to find out if there’s a way to recall information more than 30 days old but is informed that there’s no 30-day window. Danny goes to Mary to demand the Pyxis information; when they receive it, it shows no record that Charlie ordered digoxin the night of Reverend Gall’s death.

Chapter 44 Summary

In November 2003, the detectives begin scheduling interviews with nurses at Somerset. Mary sits in on the interviews, which bring forward little information. Amy, meanwhile, struggles with the paranoia of her peers, especially because the other nurses start to speculate about her and Charlie. After weeks of building anxiety, Amy is called in for an interview and decides to “let it all out” (178).

Chapters 39-44 Analysis

This section contains one of the most damning moments reinforcing one of the book’s main themes: The Fallibility of Institutions. Somerset is found to have been lying about the Pyxis machines, intentionally hiding a useful resource from the police detectives. In doing so, they not only stalled the investigation but also gave themselves the opportunity to cover up their own culpability. Charlie is let go from his nursing role in a vaguely worded termination, eliminating the risk to Somerset patients but opening the door for his crimes to continue elsewhere. The hospital’s actions are thus both legally and morally wrong—proof that those in charge are more focused on profit and reputation than on human well-being.

The author establishes the relationship between Amy and Charlie as one of genuine caring. This serves two primary purposes for the rest of the book. First, it reveals how well Charlie deludes others. While he’s repeatedly described as “a loner” and “weird,” when he wants to make a connection, he can. His manipulation of Amy stems from his willingness to help her and from his own self-deprecation. Snippets from Amy’s perspective make it clear that Charlie can change how others view him, which makes Amy a more sympathetic figure given her confusion and concern. In addition, their relationship foreshadows the struggle she faces when ultimately deciding to work with the police. This implicated internal conflict adds tension to the investigation, increasing the stakes as Amy faces risk.

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