Netflix’s The Good Nurse tells the chilling true story of Amy Loughren, the nurse who helped pin her coworker, the prolific serial killer Charles Cullen, in the murders of dozens of defenseless hospital patients. Starring Jessica Chastain as Loughren and Eddie Redmayne as Cullen, the film draws its real-life facts from journalist Charles Graeber’s true crime book of the same name.
In director Tobias Lindholm’s hands, the film, based on a script by Krysty Wilson-Cairns, is a powerful portrayal of Loughren’s heroism, side-stepping the modern true crime obsession with sensationalizing the evil killer at the center of the story. It’s a carefully paced, thoughtfully wrought narrative, weaving together shocking true details, from Loughren’s life-threatening heart disease to Cullen’s refusal to admit just how many of his victims were truly counted. But how closely does the cinematic adaptation line up with the real-life story? Here are a few key areas where the film creatively deviates from the true story.
In real life, Loughren was a tough, busy nurse working at Somerset Hospital in New Jersey and living in upstate New York with her two young daughters. She had cardiomyopathy, a form of heart disease that caused her to have gasping episodes at work. (As the film portrays, there really was a night when Loughren was struggling to breathe and was aided by Cullen, whom she told about her condition shortly after.) In one dramatic episode, Loughren collapsed at work and had to go to the ER and get a pacemaker—a detail that became essential later on during her diner one-on-one with Cullen, though none of that is portrayed in the film.
As far as Chastain’s performance goes, the actor did a remarkable job of capturing the nurse’s calm demeanor, matter-of-fact speaking style, and occasional brassiness that spiked through her work and personal life. The two ecently did a side-by-side interview with CBS, further highlighting the accuracy of Chastain’s portrayal.
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In the film, Lindholm took great pains to keep Cullen’s personal life shrouded in mystery, refusing to go deeply into his inner world. In an interview with Entertainment Weekly, the filmmaker said he wanted to present only the details about Cullen that Amy knew. “We never offer any knowledge about Charlie that she doesn’t have,” he explained, saying he didn’t want audiences to identify with Cullen, or become too fascinated by him. It’s one of the more remarkable achievements of the film, which keeps the focus on the right people instead of opening the door to potentially exalt the wrong ones.
Per Graeber’s book, Loughren’s first impression of Cullen was that he was a “sensitive soul…a sad Mr. Rogers type, both drippy and depressed.” Cullen told her about his youth, confiding that he came from a working-class Irish Catholic family and had a “miserable” childhood. He attempted suicide as a preteen; as Graeber notes in his book, Cullen would have at least 20 more suicide attempts over the course of his life. He then joined the Navy but was discharged in 1984. It was then that he decided to become a nurse, which he found suited him. He eventually got married to a woman named Adrianne Taub. The couple settled in Phillipsburg, New Jersey, and had two daughters, but the marriage dissolved as a result of Cullen’s erratic behavior. Adrianne filed multiple restraining orders against Cullen, claiming a fear that, per the book, if he was left alone with their daughters he would “impulsively take his life and theirs.”
Cullen was eventually arrested for the serial murders in 2003; he was 44 years old and was quickly dubbed the Angel of Death in the media. As the film notes, the authorities were able to identify 29 victims who had died at Cullen's hands. Cullen guessed that he had killed around 40 people, though investigators believe the true number was closer to 400. As the film notes, Cullen never explained why he did what he did. Loughren has her theories, telling CBS that she believes it was “an obsessive-compulsive disorder gone awry.”
As far as the performance goes, Loughren also said that star Redmayne did “an incredible job” portraying Cullen: “I hear his voice and it’s my friend Charlie all over again.”
In the film, Loughren slowly realizes that two patients died of insulin overdoses, noticing the unusual mistake on their respective health charts. She slowly puts the pieces together, concluding that Cullen was discreetly injecting IV packs with lethal doses of medications such as insulin.
In actuality, Cullen’s errors were slightly more flagrant. In the book, Graeber writes that Loughren looked at Cullen’s charts on a system called Cerner, and discovered that he had “the worst charting Amy had ever seen. There were blotches of words here and there, blurts, spasms of hurried and misspelled observations.” The system also showed Loughren the unusual amount of time Cullen spent browsing through the system and tracking the patients of other nurses (extremely uncommon, the book notes), then injecting those patients’ IV bags with a “drug cocktail” that led to their deaths.
In the film, Loughren keeps her two young daughters in the dark about Cullen's crimes, protecting them from the fact that their family friend was a deadly killer. But in real life, Loughren talked to her 11-year-old, Alex, about her suspicions; Alex convinced Loughren to speak up and tell law enforcement to pursue Loughren. “I told her, ‘Our lives might completely change. I don’t know if I can do this to you,’” Loughren recalled in an interview with People. “And Alex said, ‘Mom, he's murdering people.’” With that encouragement, Loughren continued apace, helping detectives Danny Baldwin and Tim Braun crack the case.
In a pivotal scene, Loughren agrees to wear a wire and sits down at a diner with Charlie, with the goal of getting him to confess to his crimes. That did happen in real life. But according to Loughren, The Good Nurse takes a few liberties with Cullen’s response to her prodding. In the film, Redmayne plays Cullen like he just might break, before thinking better of it and rushing off to go to his new nursing job.
In real life, the whole confrontation was close to being scrapped. Loughren had recently had a pacemaker installed in her heart and the detectives refused to put a wire on her, worried it could endanger her health. Loughren convinced them otherwise, telling them it would be okay. “They talked about shutting this down, so I had to talk them into it,” Loughren told Glamour. “The truth is I didn’t know how this would affect my heart, but I knew I needed to go in there and get that confession.”
When Loughren confronted him about the murders in real life, Cullen was more confident and combative than the film suggests. “He sat straight up,” Loughren recalled to People. “The color of his eyes changed. He put a smirk on his face and said, ‘I’m going to go down fighting.’” As the film portrays, he did not confess but was later arrested by local authorities.
The Good Nurse closes the chapter on Cullen with a chilling series of scenes in a cell. Cullen refuses to confess to the police, only revealing what happened when Amy comes in and gently coaxes the truth out of him, after draping a cardigan over his shoulders, a detail that the film drew from real life. The film’s version of events is accurate, though it doesn’t quite capture one key detail: Once Cullen started confessing, Graeber wrote, he spoke for seven hours. After his subsequent trial, Cullen was later sentenced to 18 consecutive life sentences.
Though the film ends Loughren and Cullen’s relationship there, before Cullen’s trial, that wasn’t the last time they saw each other. The two exchanged letters, and Loughren visited Cullen in prison dozens of times. “I really wanted to know if I had harmed someone accidentally and I wanted answers and closure,” she told Glamour, noting that she ultimately did not get the answers she wanted. “But,” she added, “I was able to see how charismatic he was and how easy it was to be drawn in. It was a process of being able to forgive myself for not seeing it.”
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