James Strickland’s death at Somerset Medical Center followed a crisis that initially left him alive but gravely ill. Charles Cullen later killed him with a midnight dose of digoxin, concealed from both the patient chart and the medication-dispensing records. The interval between the visible emergency and the undocumented fatal dose makes the death a stark example of how Cullen could turn routine clinical access into an unrecorded opportunity to kill.

The First Crisis

During Strickland’s earlier crisis, his grandson noticed a slight twitch in his arm. As the day wore on, Strickland’s condition deteriorated into a full seizure; nurses administered glucose, but he continued to crash. Cullen reviewed the patient’s numbers on the Cerner system and revisited the sequence of events. Strickland survived this episode in body and remained at Somerset Medical Center, but survival did not end his exposure to Cullen.

The Fatal Dose

Two weeks later, Cullen finished Strickland with a midnight dose of digoxin. The timing and the choice of drug gave the killing a different shape from the earlier emergency: rather than a crisis unfolding in front of staff and family, it was a fatal intervention that left no evident medication trail. The account later identifies massive doses of digoxin as the means by which Cullen stopped Strickland’s heart, confirming the drug’s lethal role.

The Missing Record

Digoxin appeared nowhere on Strickland’s chart, and Cullen had made no corresponding request through Pyxis; there were no canceled digoxin orders either. The absence of an order did not mean the drug had not been given. It meant that the usual records could not connect Cullen to the dose, and the narrative’s terse judgment that he was good at this points to concealment as part of the act, not an afterthought.

Strickland’s case also sits within the repeated pattern Cullen describes through remembered patients and varied drugs: a patient’s existing medical vulnerability offered opportunities to worsen or redirect a clinical crisis. The narrative moves from Strickland’s observable seizure to a death that left no trace in the systems meant to document medication use. Its force lies in that contrast: the first emergency was loud and witnessed; the fatal dose was midnight, unrecorded, and difficult to detect.