Pennsylvania is one of the principal settings through which the book traces Charles Cullen’s movement from hospital work to criminal investigation and, ultimately, to court. Its significance is not presented as a single statewide institution or a self-contained chapter of the case. Instead, the narrative locates key scenes in medical workplaces, at Cullen’s home in Bethlehem, and in the Lehigh County Courthouse in Allentown. These places mark a shift in what can be seen: the private routines and access of hospital work give way first to a search for physical evidence, then to a crowded public proceeding.

Medical Work and Access

At Saint Luke’s Hospital, the book depicts how ordinary nursing routines could conceal dangerous acts. In one episode, Cullen injected digoxin into an elderly patient’s IV through its piggyback port, a connection nurses routinely used to flush a line. The action looked like legitimate care; after putting the vial and needle in the sharps box, he returned to the nurses’ station and waited for the emergency, later taking a visible role in the code response. The patient’s room and the accepted procedure made the act difficult to distinguish from treatment.

Another Saint Luke’s scene follows Cullen into the medical supply room after he collected medicines delivered by a pharmacy runner. Alone behind the coded door, he prepared syringes and injected saline bags, then left the altered medication in the named patient trays. He also noticed Pronestyl on the shelf, newly stocked. The sequence matters geographically because the room’s restricted access, the delivery route, and the routine work of stocking supplies form a connected interior landscape: Cullen could appear helpful while moving through spaces and tasks familiar to the staff around him.

The hospital’s access controls did not prevent suspicion from gathering. After a dangerous paralytic was found prepared in syringes despite no patients having a prescription for it during the weekend, nurses Gerry Kimble, Candy Wahlmark, and Kim Wolfe took turns watching the medical storage room. Wolfe saw Cullen arrive early, wheel extra chairs down the hall, enter the room using its access code, and disappear behind the door. She and Candy had already been watching other entrants, including a person they did not recognize and a pharmacy worker, but the surveillance brought the familiar colleague into focus. The hospital corridor and coded door became not merely parts of a workplace but points in an emerging inquiry.

Bethlehem and the Search

The investigation reached Cullen’s residence in Bethlehem when detectives and prosecutors served a warrant on his girlfriend, Catherine Westerfer, and searched his house and car. The search lasted three hours and focused chiefly on controlled substances that Cullen might have taken from a hospital. It yielded a blister pack of pills, a bottle of CVS allergy medication, and a bottle of ibuprofen. Investigators emptied, counted, photographed, and bagged the contents for storage at the Northampton County District Attorney’s Office; later analysis found nothing stronger than cold medicine.

The result exposed the gap between investigative urgency and what the search could prove. Danny Baldwin had vouched for probable cause and worked with the prosecutor on the warrant’s language, accepting that responsibility before the search. On the interstate ride home, the detectives sat in uncomfortable silence. The objects collected in Bethlehem were real evidence, carefully handled, but they did not provide the decisive drug evidence the investigators had sought. Pennsylvania thus held a consequential investigative scene without supplying an immediate resolution.

Allentown and the Courthouse

The book’s most formal Pennsylvania setting is the Lehigh County Courthouse in Allentown, where the narrative places proceedings on March 20, 2006. The city is described through the contrast between the remains of its former industrial wealth and a worn public center: imported stone and high colonnades stand alongside people searching for cans. Families of victims arrive in dark formal clothes, identified by small blue OfficeMax stickers on their lapels. Their presence gives the courthouse approach a human weight before the legal proceedings themselves begin.

The courthouse interior sharpens that contrast. Much of the old building has been gutted during a stalled renovation, so families are guided through stripped rooms, file cabinets, stairs, and flickering halls before reaching a bright nineteenth-century courtroom. There, marble, gilt, ornate railings, and a ceiling forty feet overhead create an imposing ceremonial room. The route through the building makes the courtroom feel like a destination reached through institutional disrepair, rather than an uncomplicated monument to justice.

Cullen enters this room chained at the hands and manacled at the legs. The restraints make him look physically dangerous, an impression the narration distinguishes from the actual situation. In the courthouse, the concealed and procedural character of his earlier hospital access is replaced by a visible body under restraint and by victims’ families gathered in the same public space. The setting gives the case a new scale: the consequences that had been dispersed across medical rooms and investigations are now represented together before the court.

Pennsylvania in the Case’s Geography

Pennsylvania’s places perform different roles rather than merging into one backdrop. The hospital scenes show the intimate spaces and routine access through which Cullen could act without attracting notice; Bethlehem becomes the site of a search that produces carefully documented but inconclusive material; and Allentown concentrates the case’s public and legal dimensions. The movement among them turns geography into part of the investigation’s structure, carrying the story from clinical spaces where events could be mistaken for medical emergencies to a courtroom where the accused and victims’ families occupy a shared, visible setting.