Cullen Kills Matthew Mattern with Digoxin

Charles Cullen’s killing of Matthew Mattern at Lehigh Valley Hospital transformed a burn patient’s grim prognosis into an opportunity for deliberate murder. On August 31, 1999, Cullen loaded Mattern’s IV with a bolus dose of digoxin; before sunrise, the young man’s slow code was over. The episode joined Cullen’s private compulsion to exert control to the routines of overnight nursing, where he could act in a patient’s room and then take charge when the crisis became visible.

Mattern and the Burn Ward

Mattern had been trapped in a burning car wreck and arrived at Lehigh Valley Hospital with burns over 70 percent of his body. He was twenty-two. His presence changed the emotional temperature of the burn ward: young visitors came in distress, while nurses saw in him sons, grandsons, friends, lovers, or even themselves. Staff members privately used the Rule of Nines to reckon with his chances, estimating that he was 92 percent likely to die. Survival remained possible, but death seemed far more probable.

The nurses called his condition a slow code, a Code Blue unfolding in slow motion. Even if Mattern survived and his transplants took, Cullen understood that he could be left profoundly disabled, an amputee enclosed in scar tissue and a pressure suit. Surgeons removed his burned extremities piece by piece; nurses thought of the process as butchery, and many privately prayed for the death they considered inevitable. That despair surrounded Mattern before Cullen acted, but it did not make the killing an act of care: Cullen’s intervention brought about the outcome the ward feared while substituting his own decision for the patient’s course.

A Pattern of Control

Cullen regarded himself as an experienced burn nurse, especially after working in the Burn Center at Saint Barnabas Medical Center, but at Lehigh Valley Hospital he felt treated like a novice. He found the other nurses’ attitude toward patients heartless and called them cold and cruel; they regarded him as a weirdo. The hostility echoed his earlier experience in the United States Navy, where hazing had made him feel powerless as a new sailor. At the hospital, however, he was no longer the newcomer. He could intervene in patients’ lives during long overnight shifts, and the sense of helplessness he associated with the ward became, in his mind, a situation in which he could exercise personal will.

That self-understanding did not mean he was responding to Mattern as an individual. Cullen’s interventions had become compulsive stress-relieving acts: he often attended to patients’ outcomes rather than to the patients themselves, and each episode of control brought him a temporary release followed by an afterglow. The pattern continued through the summer and into the fall and winter, recurring amid the strain of the holidays. Mattern’s death thus belonged not simply to the burn ward’s expectation of a fatal outcome, but to Cullen’s repeated conversion of professional access into private control over life and death.

The Killing and Its Immediate Aftermath

On August 31, 1999, Cullen loaded Mattern’s IV with a bolus dose of digoxin. Before sunrise, the slow code had ended. Some nurses thanked God for what they understood as an intervening grace; Cullen simply returned to the parking garage. The contrast left the ward’s fatal expectation intact but altered its meaning: what appeared to others as the end of an almost hopeless case was, for Cullen, an outcome he had deliberately brought about.

The Wider Pattern

Mattern’s death occurred within a sixteen-month stretch of overnight work at Lehigh Valley Hospital. Cullen could not later recall the specifics of many patients he had intervened with, including whether they had arrived after car accidents or house fires, or how many there had been. Most died during his shifts, coding in front of the nurses he had judged cold. Against that indistinct background, Mattern’s case stands out for the detail the account preserves: a twenty-two-year-old burn patient, a prognosis the ward considered nearly hopeless, and a deliberate dose of digoxin. Cullen’s inability to recall the individual circumstances of other interventions underscores how little his acts depended on knowing the people in his care.