60 pages • 2 hours read
Charles GraeberA modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
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Adrianne calls the police one night in January 1993, alleging domestic abuse and telling the officers about all of Charlie’s oddities and cruelties. Charlie attempts to die by suicide through ingesting drugs, and the author shares his history of similar attempts. His first occurred when he was nine, a second after his mother’s death, and then several while in the Navy. While recovering at Warren Hospital, Charlie speaks with a nurse named Michelle who is sympathetic toward his feelings of sadness and his situation. Charlie has romantic feelings for her, and Michelle is drawn to his charming side. Charlie and Adrianne start their divorce proceedings, and Charlie moves into a basement apartment in Phillipsburg. Michelle and Charlie start to date.
Charlie falls in love with Michelle, but his intense emotions aren’t reciprocated. She ignores his frequent gifts and, when he confesses his love, starts to avoid him. He starts to call her repeatedly until Jerry, Michelle’s on-and-off boyfriend, answers the phone and tells him to stop. Charlie thinks that Michelle is sad but that he can save her.
In March 1993, Charlie begins to drive by Michelle’s condo. He spends a night driving between his house and hers, calling her each time he arrives back home. He breaks into her house and watches her sleep before calling her from a convenience store, where she explains that someone broke in. He confesses and gives her permission to call the police before returning home. The police call him and inform him of a warrant for his arrest. Charlie takes drugs before leaving for the station, intending to die by suicide, but isn’t formally arrested and is instead questioned about the evening. He calls his children’s babysitter for a ride to the hospital after the questioning concludes.
In April, Charlie is sent to Greystone Psychiatric Hospital, where he flourishes in the new environment and absence of stressors. In May, he receives a note to call Warren Hospital. Charlie suspects that the hospital has linked unexpected patient deaths with his presence. He’s astounded to learn that despite the drama he caused, which includes his stalking Michelle, he’s invited to return to work at the end of his hospitalization.
Charlie returns to his apartment and begins a garden because he seeks meaning in his life. Charlie is moved to the telemetry ward of Warren so that he doesn’t interact with Michelle. Here, patients who need to be monitored but no longer in critical condition wait to be moved elsewhere or released. As Charlie applies electrocardiogram electrodes to patients, he reflects on how this machine is like a lie detector test and on his own successful test, taken in an effort to maintain custody of his children. His court troubles encompass his stalking charge as well. Charlie tries to hire an attorney, but the lawyer quits after three days because Charlie is difficult to work with. He begins to write rambling letters before pleading guilty to a lesser charge. He attempts to die suicide, is sent to Warren, and is released the next day.
Charlie writes letters to the judge of his stalking case before visiting the counselor who will determine the custody arrangement for his divorce. The counselor notes that his frequent attempts to die by suicide are a form of attempted abandonment. This, in addition to Adrianne’s other evidence, prevents Charlie from gaining custody.
In September 1993, Charlie injects a patient named Helen Dean with digoxin, a drug that slows the firing mechanisms of the heart. Charlie asks her son, Larry, to leave her room before the injection. By the next day, her heart has stopped. Larry questions the hospital staff and reports Charlie to the police for murdering his mother. When Charlie returns to work and is questioned about her death, he denies everything. The coroner fails to test for digoxin and thus the death is ruled to be of natural causes. Charlie is placed on leave and again attempts to die by suicide.
An escalation of Charlie’s behavior is reinforced by the system’s acceptance of his behavior. Although this section of the book focuses primarily on Charlie’s mental illness and personal relationships, the author peppers these descriptions with direct mentions of the continuation of his medical crimes. The references to bodies and patients establish that even during Charlie’s personal distractions, he continues to harm others. His self-identification as a “victim” colors all his experiences, as he portrays events through the guise of someone who has been hurt rather than someone who is hurting others. This is evident, for example, in his obsession with Michelle. His own stance on his romantic efforts creates a haze, which helps him nullify the horror of his actions and reinforces that he considers himself a top priority and disregards others’ rights.
Charlie’s second hospital establishes a pattern that repeats throughout his criminal activities—a general acceptance of him despite the indications that he’s a danger to himself and others. He stalks a fellow nurse and breaks into her home but is welcomed back to work at Warren Hospital following his psychiatric release. They disregard the mental and emotional trauma he caused, just as they continue to fail to notice how patient difficulties align with his shifts. Charlie’s killing of Helen Dean (which may be his first murder) reinforces this pattern. Despite eyewitness testimony, Charlie gets away with his crime and remains free to continue hurting people. His paid administrative leave essentially rewards his murderousness, contributing to his sense of immunity.
Charlie’s early criminal days provide significant evidence for the Fallibility of Institutions—evidence that continues compounding throughout the rest of the book. Hospital institutions fail their patients and staff by allowing Charlie to continue practicing medicine. Mental health facilities fail Charlie by not providing him with the necessary tools to heal from his childhood trauma and grow in positive ways. Legal institutions fail to identify Charlie as a threat, thus enabling his crimes, which span more than a decade. The narrative highlights how institutions that interacted with Charlie either failed to have the resources or intentionally failed to protect their own interests. This section of the book encourages a mindset of questioning authority and builds concern and suspense.
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