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

Charlie is the book’s focus and antagonist. Described as a pale, slender man, he sometimes wears glasses or sweaters. He’s quiet and referred to as a “loner” or “odd” by his peers, struggling to fit in for much of his life. His quietness, awkwardness, and desire to be helpful hide his true, dangerous self from those around him. During his 14 years as a nurse, Charlie overdoses many patients, often fatally. He ends the story convicted of 13 murders, but case experts believe the number is as high as 400.

A difficult childhood, struggles with alcoholism, and frequent bouts of sadness lead Charlie to self-identify as a victim for the entirety of the text. He tells stories in a way that pin him as the sympathetic party, playing up his crimes and attempts to die by suicide for laughs. His self-deprecation is disarming and leads people around him to disbelieve his malicious intentions, aiding his overall lack of detection. Crucially, however, Charlie genuinely and consistently believes that he's the one who deserves sympathy. While some of his behavior may be intentionally manipulative, both Amy and Graeber observe that he honestly thinks himself as a victim because of his childhood traumas and subsequent adulthood struggles. This is vital to understanding Charlie’s worldview, which features himself as the ultimate sufferer even in the face of his many victims.

Charlie’s biggest manipulation is that of the system in which he flourishes. He intentionally abuses institutional standards, relying on neutral references so that he can continue killing for as long as possible. Throughout most of the story, he manipulates human resource departments and administrators, which shows a level of emotional intelligence that he doesn’t practice in his personal life. Furthermore, he manipulates technology and systems to achieve his desired ends. His actions highlight the need for greater security measures and institutional standards, because more oversight could have prevented most of his machinations.

A coworker of Charlie’s at Somerset Medical Center, Amy is an attractive blonde woman who describes herself as being difficult, often loudly advocating for what she thinks is right. As a child, she experienced years of sexual abuse at the hands of a trusted family friend and has subsequently spent time in therapy trying to overcome the trauma of that event. This early-life betrayal makes it difficult for her to open up to people, and she frequently notes that she behaves in a performative way when around others. While working with Charlie, she had surgery to have a pacemaker put in due to a heart condition that negatively impacted her health. She ends the story transitioning out of nursing and into therapy to help others overcome their trauma.

Amy performs two central roles for Graeber’s narrative. First, she provides a grounded perspective on Charlie and his manipulative nature. Amy’s behavior and attitude reveal that she has a low tolerance for nonsense and misbehavior, yet she’s drawn to Charlie. He creates a version of himself that is gentle and timid, making it difficult to imagine him as a criminal. This establishes how Charlie influences the people around him, helping show the chasm between the nurse Amy knows and the killer the narrative reveals. Amy’s second role in the narrative is as the police liaison who provides vital insight and information. Without her, the case wouldn’t have been constructed so quickly, if at all. Her knowledge of medical jargon and familiarity with Charlie make her invaluable to the detectives.

Amy has a very strong moral compass that, rather than clarifying what she must do, makes her path muddy. Her gut instinct about Charlie creates a feeling of guilt that she can’t overcome, even after knowing that he’s guilty. She wants to do what’s best for the patients and the people she loves, a desire hindered by the behavior of the hospital administration and by her own uncertainty. Her intuition conflicts with her evidence, leaving her torn as to the best path. Although she ultimately helps the detectives successfully put Charlie in prison, the physical and emotional symptoms caused by the events of the story are no doubt a contributing component for her eventual change in profession.