“Over the course of his sixteen years, Charles Cullen had been the subject of dozens of complaints and disciplinary citations, and had endured four police investigations, two lie detector tests, perhaps twenty suicide attempts, and a lock-up, but none had blemished his professional record. He’d jumped from job to job at nine different hospitals and a nursing home, and had been ‘let go,’ ‘terminated,’ or ‘asked to resign at many of them.’”

In the biography’s opener, Graeber summarizes Charlie’s turbulent record and how he continued practicing nursing for so long. This establishes the confirmed facts of Charlie’s case, foreshadowing the events to come.

“Charlie considered it one of the neater equations in life: the world pushed, and the pressure suit pushed back.”

Charlie’s overall cold nature and tendency toward calculation is evident early in his nursing career. Rather than empathizing with the patients in the burn unit, one of the more traumatic units to which a patient can be admitted, Charlie instead focuses on technology and logic. This obsession with technology later manifests in his abusing it to enable his crimes.

“It never ends well for saints, no matter how good they are. Castration, defenestration, hot pincers, prison—the saint is a scapegoat, a martyr, a patsy. Barnabas was stoned to death, but his story lived beyond him. Every Catholic knew his name. It was the paradox of the saints, one thing Charlie held on to form his childhood: remembered well, remembered forever, but only after being hated to death.”

A central conceit of martyrdom is the idea that a divine afterlife will alleviate earthly suffering. Charlie interprets this as a concept to support human suffering rather than healing, which morphs into abuse and murder.