For The Good Nurse brain trust of director Tobias Lindholm and writer Krysty Wilson-Cairns, the question is how, not why.
In the Netflix thriller-drama, Lindholm and Wilson-Cairns tell the true story of how a compassionate ICU nurse named Amy Loughren (Jessica Chastain) managed to take down fellow nurse Charles Cullen (Eddie Redmayne), arguably the deadliest serial killer in American history. Loughren showed tremendous bravery at a time when she was not only raising two daughters by herself, but also dealing with a life-threatening heart condition without health insurance.
The film also puts a spotlight on the many hospitals that turned a blind eye to Cullen’s behavior, exposing even more flaws in the U.S. healthcare system. Cullen ultimately pled guilty to the murders of 29 patients, but the actual number over the course of his 16-year nursing career is in the ballpark of 400.
For Lindholm, Cullen’s motive, or lack thereof, is less important than the how of it all.
“Why he did it is not as interesting a question as how he was allowed to continue to do it. For me, that was the most frightening question. Understanding that somebody could have stopped him but didn’t, for profit, that was where I could feel the burning in my soul. That particular why is the reason for this film,” Lindholm tells The Hollywood Reporter.
Wilson-Cairns has quickly become the film industry’s go-to writing partner as she co-wrote 1917 with Sam Mendes, receiving an Oscar nomination in the process. She also co-wrote 2021’s Last Night in Soho with Edgar Wright, and she’s currently co-writing Taika Waititi’s Star Wars film, which remains in development.
However, despite its 2022 release year, The Good Nurse actually predates all of these projects as it was her first professional writing job. Wilson-Cairns credits producer Darren Aronofsky for taking a shot on a virtual unknown seven years ago, as well as author Charles Graeber, whose book, The Good Nurse: A True Story of Medicine, Madness, and Murder, she adapted. Wilson-Cairns also singles out the real Amy Loughren for giving her blessing.
“When I eventually met Amy, I was quite nervous. I didn’t have a credit to my name and no films to show her,” Wilson-Cairns recalls. “So I basically turned up and was like, ‘I really believe in this story. I really believe that the world should see what you’ve done. Will you help me?’ And she said yes. She was integral to every part of the process for me.”
In a recent conversation with THR, Lindholm and Wilson-Cairns also discuss the film’s long road to the big screen, as well as the license they took in adapting the story.
Krysty, in the last few years, you’ve become the world’s most popular writing partner (1917, Last Night in Soho, Taika Waititi’s upcoming Star Wars movie). So where did The Good Nurse fall on the timeline of events?
Krysty Wilson-Cairns: (Laughs.) The Good Nurse was my first paid job. So it came before 1917 and Last Night in Soho, but it didn’t really get going until Tobias came on board as the director. That’s when we really got it into shape. So it started seven years ago.
Why did The Good Nurse take this long to come to fruition?
Wilson-Cairns: It’s a tough story to tell. It took us a long time to get the script right, and then it was also a tough story to produce. It was tough to pull off in every kind of shape of the word, and we needed a magical confluence of various things for it to happen. And Tobias somehow did that.
Tobias Lindholm: I don’t really understand it because now it seems so easy. (Laughs.) When I read Krysty’s first draft seven years ago, I was on my way over to do a couple of episodes of Mindhunter together with David Fincher. So we started the process there, and what we agreed on in our first meeting was to get rid of all the references to other serial killer movies. We cleared out the space so that only details from reality, the real nursing world and Amy’s real home would build the tension. Clearly, that is a difficult task because we are all slaves to those conventions. We make these references to other films all the time.
So in the beginning, it took a while to figure this out, structurally, but Krysty had everything there. The struggle was to find the right basic structure for it to become a friendship story so that we could use that friendship and humanity to stop the most prolific serial killer in American history. That was what Amy [Loughren] had done, and so we had to figure out how we could structure the screenplay in a way that would prove that. So I think it was that [that caused the long development time].
And then it’s just the fact that nobody really wants to challenge the genre. I mean, it’s clearly a great sell; true crime is huge all over right now. But to convince everybody around us that this was the best way to tell the story wasn’t necessarily easy until we suddenly found a way to get the script into place. And then, from that point, it actually went pretty fast.
JoJo Whilden/Netflix
Tobias, you’ve directed a few of your own scripts in the past, but you mostly go back and forth between writing and directing. Is there any rhyme or reason to this?
Lindholm: Well, I’m an educated screenwriter, and my way into film is through the writing. In this case, what made the biggest difference was that Krysty was there. So I had the luxury of leaning on somebody that I considered even more talented than myself.
Lindholm & Wilson-Cairns: (Laugh.)
Lindholm: And suddenly, I could just be the director who gives notes and troubleshoots and doesn’t have to do the hard work. I’ve been with directors where you get all these notes, and then once the director leaves, you have no idea where to go from there. So I was not that person this time. That was all on Krysty. But it’s been a great joy, and what Krysty and I basically share is a common language about what makes a good scene and how a good scene is written. So I felt very safe and welcome in Krysty’s place as a writer, and that was the reason why it worked out this way.
When Jessica Chastain won her Oscar in March for The Eyes of Tammy Faye, how quickly did the two of you think of the symmetry it would create on your poster and in the trailer, as both your leads were now Oscar winners?
Lindholm: I will be very honest. I was on my knees yelling out of joy, not because of what it could do for our marketing, but because Jessica is such a hard worker. She’s the hardest working actress out there, and to see that she got it together with her team of makeup artists was just such a joy. There was one other thing that I remember from that Oscar event, but when Jessica and her team got their awards, I was over the moon. Of course, I was also happy that the marketing would now say two Academy Award winners, but during the shoot, it was just Eddie [Redmayne].
Wilson-Cairns: I mean, I really didn’t think of the marketing. Having worked with Jessica and [makeup artist] Linda [Dowds] and her entire team, I was just really happy for my friends because I thought they deserved it. I thought The Eyes of Tammy Faye was unbelievably brilliant from top to bottom, so I was just pleased for the hardworking people that I know. And then, of course, yeah, you do think, “Oscar winner Jessica Chastain and Oscar winner Eddie Redmayne in Tobias Lindholm’s The Good Nurse has quite a good ring to it, doesn’t it?” (Laughs.)
Lindholm: It’s a poster that you’ll want to keep in your office for a year or two.
Wilson-Cairns: (Laughs.) Exactly!
How much did the two of you rely on the real people involved such as Amy Loughren?
Wilson-Cairns: I met her before I started writing, before I even put pen to paper. After I got the job, I came out to New York and I met Charles Graeber, the author of the book [The Good Nurse: A True Story of Medicine, Madness, and Murder]. So he gave me a huge amount of access, but he was also vetting me to make sure that he felt comfortable introducing me to the detectives, [Danny] Baldwin and [Tim] Braun, and then to the real Amy Loughren. So I was really put through my paces by him, and then when I eventually met Amy, I was quite nervous. I didn’t have a credit to my name and no films to show her. So I basically turned up and was like, “I really believe in this story. I really believe that the world should see what you’ve done. Will you help me?” And she said yes. She was integral to every part of the process for me, and then she went on with Tobias, Jessica and Eddie. She became a real key collaborator.
Lindholm: When I had read Krysty’s first draft and Graeber’s book, the foundation of the film I saw there seemed too good to be true. So I had to get with her and confirm some of these things. I mean, the fact that you have a single lonely mom struggling with a heart condition, offering comfort and care for everybody else, but not being allowed the care she needed herself, almost seemed like a piece of the Book of Job in many ways. How much can we do to this woman before she breaks? And then on top of that, she used her kindness in her conversations with Cullen and in stopping him. So all of that felt too perfect in a way.
So I needed to talk to her about that, and she was very, very open. I had a long lunch with her, and we kept calling each other for months anytime I had any doubt or thoughts that I wanted to talk to her about. I am from Denmark, and we have a totally different healthcare system in Denmark. So there were many things that I didn’t really understand, and her wisdom and logic was very helpful throughout the whole process. And then as we got closer to shooting, clearly her and Jessica spent time talking together. She and Eddie talked because she was a perfect witness of how Charles Cullen was. And then she was with us on set a couple of times while we were shooting. I also talked to her in the edit whenever I changed stuff to make it even better. So she’s been very close to us all throughout.
JoJo Whilden/Netflix
Generally speaking, in what ways did you take license from the source material?
Wilson-Cairns: I suppose the biggest license we take is compressing some time and having it feel more cinematic. In the first meeting [between Amy and Charlie], there’s a sort of instant connection that’s been added, but only slightly to make the format work. We left out the first two-thirds of the book, which was Charles Cullen’s whole life. We were never going to see that because we were going through Amy, but it’s still in there in some sense. There’s still some understanding of it for Eddie, but we really didn’t change a lot. True life really worked for us.
Lindholm: I agree. It’s the time compression. I remember Fincher teaching me that cinema, more than anything, can make a year feel like a second and a second feel like a year. That’s where the magic and the storytelling happens. They did work together for more than a year, or just about, but it felt like the timing of Amy’s heart condition needed to be the base of the rhythm throughout the storytelling. From an ethical point of view, we changed most names. So we have the names of our heroes, Braun, Baldwin and Amy, clearly, and Amy’s daughters. But other than Charlie Cullen, we changed most of the names on both sides.
We were not out to retraumatize any victims in this, but we were also not out to point at any individuals in this system and blame them. What we tried to do was to make a thriller-drama that would in itself prove some of the mistakes in this system. It was the system that was the problem, and that was a conscious decision. It wasn’t something lawyers asked us to do afterwards. It was something we decided to do to not blame somebody’s mother that we have never met and who probably had reasons to do what she did. It just made sure that it became a story about a broken system.
As you just touched on, this story exposed even more flaws in the U.S. healthcare system. Did this case lead to a number of safeguards as well as overall reform? Is it impossible for this to happen again?
Lindholm: I’m afraid that it’s [still possible]. The screening processes in hiring nurses changed a bit, but we still have an American healthcare system that is basically there for profit. And when that happens, there is a big risk that it can lack humanity. I think that’s the case with all these institutions and big systems we built to make our own lives easier. We’ve suddenly realized that they will turn against us because they are rigid and cold, and we have to bring humanity to them.
Wilson-Cairns: To my knowledge, there aren’t [any new safeguards]. Within individual institutions, there’s maybe been overhaul, but ultimately, the American healthcare system still puts profits ahead of people. And as soon as you do that, you are open to creating tragedy.
Of the many frightening aspects of this film, a nurse having to work x amount of time to qualify for health insurance is perhaps the most unsettling. And the pandemic brought this issue to light even more with regard to frontline workers, leaving people to wonder, “Who’s taking care of the people who are taking care of us?” So it certainly sounds like commenting on American healthcare was very much a priority here.
Lindholm: We tried to structure the first act by pinpointing all the real struggles Amy was facing, down to her being yelled at because she was kind to a relative who she let stay overnight. So making sure that this harrowing truth was part of the DNA of the film and not just a statement in the film, led us to begin with her being very humane towards the patients and then coming home to be a struggling single mom. Then we learn she has a heart condition, and she’s back at work where she’s still not able to get help. When we figured that out, it felt like we had placed the core of the problem and the core of the story right there. And from then on, we all knew that she needed a friend and someone in her life that could carry her through. We understood the struggle and that the system was rigid and inhumane, so somebody else had to bring humanity there. So that was the premise from the beginning.
Krysty, how much U.S. healthcare commentary was in your script?
Wilson-Cairns: After watching the film, there’s just the right amount. Originally, I wanted to absolutely go for the kidneys of the American healthcare system and gut it, because I find it totally shocking that a family can lose their home once their kid gets leukemia. I find that absolutely galling, and it’s so foreign to me. But when I think about the real statements that you want to make with that stuff, you do that through documentaries. You do that through the news. You let people see that truth and confront it firsthand.
For me, there’s two villains in this. There’s the serial killer and there’s the system, and there was always the delicate handoff between those two villains so that you could understand it. In a film, if you don’t do it through someone who you love, who you care about, who you understand, I think it can feel a bit like you’re forcing an audience to eat their vegetables. So it was always really important to us that this was through Amy’s prism and story. And that meant that there had to be a level of like, “Okay, here’s the bad guy, here’s the other bad guy, but here’s the thrust of it and what we feel and what we experience.” So you get to feel the unjustness of the fact that she hasn’t got healthcare, but it’s not in every single scene, which is probably what I originally wanted to do.
The two of you worked with a producer named Darren Aronofsky. Did he offer any notes that were particularly helpful?
Lindholm: Well, Darren bought the book together with [producer] Scott Franklin. He’s a great collaborator and friend. He’s always been ready to help, but the biggest thing he brought to this was Krysty. Him reaching out and already understanding Krysty’s talent back then was a huge blessing.
Wilson-Cairns: This was originally with Lionsgate, but without his backing, I don’t think anyone would have ever have paid me to do it. He really threw his weight behind me, and in the early development stages of the script, he was always like, “Just go for it.” That’s what you want to hear from producers and that you’re not going to be hemmed in by budget or consideration. They just want to see the best version that you can deliver, and knowing Darren’s work is a nice place to start from.
Lindholm: I just want to add that Scott Franklin, Darren’s producing partner for years, was with us on set every day and throughout the whole thing. So the fact that my first American feature didn’t feel any different from my small Danish features with my nine friends in Copenhagen is to his credit.
JoJo Whilden/Netflix
Perhaps the point of all this is that Charles Cullen didn’t have any particular motive, but what are your theories on a possible motive?
Lindholm: While we did Mindhunter, I talked to FBI agents and the people who invented the whole profiling system. So I learned that there are several reasons, but none of them really fit. There is a combination of events where this can be the outcome, but I don’t think there is a real motive here either. As humans, we have an urge to try to create order in this chaos. We really want that answer to feel safe, and I don’t think the answer is there. Why he did it is not as interesting a question as how he was allowed to continue to do it. For me, that was the most frightening question. Understanding that somebody could have stopped him but didn’t, for profit, that was where I could feel the burning in my soul. That particular why is the reason for this film.
If Charlie had given a real answer, I don’t think we would or should believe him. I don’t think that there is a recipe for how a monster or darkness like this is created. So there’s a lot of events shaping it, but we can instead learn from what Amy brought to the table, which was humanity. We can learn that we need to look over the shoulders of these systems and make sure that they’re transparent so that it’s impossible for anyone else to do what he did.
Wilson-Cairns: Tobias said it perfectly. Why he did it can never be more important than the how because the how allowed him to do it for 16 years. And so, to me, that was the most interesting thing.
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The Good Nurse is available Oct. 26th on Netflix. This interview was edited for length and clarity.
