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How to Write the Quotidian Superhero: Krysty Wilson-Cairns Talks About Adapting 'The Good Nurse'

Krysty Wilson-Cairns, the screenwriter of this adaptation and a fresh voice on the horizon, took the time to speak with Script about the challenges of adapting a true story and how she homes into writing her drafts.

Though it’s been around for thousands of years in some way shape or form, nursing as a profession was born in the 18th century. These caregivers are supposed to aid people in their recovery from illness or injury. They are stewards of the infirm. So, it’s an aberration when they hurt their patients instead of helping them. Since the 1800s, there have been “Angels of Death” who’ve killed the very people they were supposed to be helping, often taking pleasure in it.

One of the most copious serial killers in world history was murderous healthcare worker Charles Cullen. He’s suspected of killing up to 400 people. Charles Graeber’s riveting New York Times bestseller The Good Nurse: A True Story of Medicine, Madness, and Murder debuted in 2013 and introduced the world to this prolific killer. 

[L-R] Eddie Redmayne as Charlie Cullen and Jessica Chastain as Amy Loughren in The Good Nurse. Photo credit JoJo Whilden / Netflix

[L-R] Eddie Redmayne as Charlie Cullen and Jessica Chastain as Amy Loughren in The Good Nurse. Photo credit JoJo Whilden / Netflix

On October 26, Netflix’s take on Cullen’s story airs. Directed by Tobias Lindholm (Mindhunter, The Investigation) and starring Jessica Chastain and Eddie Redmayne, the film artfully portrays the horror of silent predator Cullen. With a sinister score by Biosphere and a look of crisp starkness, the film quietly delivers this true story about overlooked, commonplace evil. Chastain and Redmayne, looking like long-lost siblings, deliver steady, honest, powerful performances. Recently, Krysty Wilson-Cairns, the screenwriter of this adaptation and a fresh voice on the horizon, took the time to speak with us about the challenges of adapting a true story and how she homes into writing her drafts. This Scottish writer’s credits include Penny Dreadful, 1917, and Last Night in Soho.

How did you make the leap from doing shorts to Penny Dreadful?

I wrote a spec script called Ether, which was the key and that's what I'd recommend writers do when they're feeling bogged down. It's a really good thing to do to learn your craft, to learn where you're going wrong, and to learn the dynamics of working with other people, which will stand you in good stead. My spec script ended up on The Black List, where John Logan and Sam Mendes read it. That's how I got Penny Dreadful.

What was your writing process like for Penny Dreadful?

It was a really small writers’ room. It was John Logan, who's kind of good at what he does. I was a little intimidated. Then it was me and Andrew Hinderaker, who's now the showrunner for Showtime's Let the Right One In. He was more of a theater writer, and I had more of a film background. It was just the three of us trying to break the story and us understanding that it was John’s vision. The characters already existed. We were so fortunate that he's such a fantastic mentor. He really took us under his wing and also pushed us to be on set, to understand how to make TV, to liaise with different departments, and to shadow a showrunner on different episodes so that when we left there we were able to understand some of the whole process. We got to be in the edit as well. I owe a lot to John Logan.

Krysty Wilson-Cairns. Photo credit Ken Dundas.

Krysty Wilson-Cairns. Photo credit Ken Dundas.

What were the difficulties of doing a feature compared to that? You got 1917.

1917 was a few years after that. The Good Nurse and Penny Dreadful I did at the same time. Good Nurse was my first paid feature job and Penny Dreadful was my first paid television one. They both happened in 2013, 2014.

How did you get attached to The Good Nurse?

Darren Aronofsky had read Ether. I'd signed with my agents, and they sent me a stack of open assignments, one of which was the book The Good Nurse, which was with Darren's company. I started pitching for it and he liked my writing. He entertained the pitch from this brand-new writer who had absolutely no credits. The producers and I worked together, and I got the job. I pitched a couple of different iterations, but they were always with Amy in the lead and thankfully they chose me.

When you did the adaptation, how did you select what you were going to leave out and put in?

It was difficult because Charles Graeber's book takes place over Charles Cullen’s entire life, and particularly over the sixteen years that he was killing. I really struggled with it. I thought, 'How do you go in? Who's going to be your point of focus?' In the last third of the book you get to Amy Loughren, and as soon as I got to her, I thought, 'This is a character that I understand, this is a character that's the closest to Charles, and also someone who understands the hospital system.’ Also, she was a single mom, a kind of superhero we rarely see. I relentlessly pitched that we see things through her eyes.

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What do you think motivated Charles?

That's a difficult question and I actually have no idea. I talked a lot about this with the director and Eddie as well. We all really felt that making up theories wasn't helpful 'cause we can't know the truth. I don't actually think the real Charles Cullen even knows. Through all the research and all the reading, we never had a concrete understanding of why. I did struggle with that for a while, particularly in the early drafts.

That makes it even more chilling, that he had no reason.

That's it. It's more frightening if we never understand it.

Why and how do you think he got away with it for so long?

I think he got away with it because of the American healthcare system and how it puts profit ahead of patients. Hospitals are run as businesses and because of that, they didn't want to fully investigate what they assumed was happening. Allegedly, they didn't know but if you read Charles Graeber's book, the evidence is pretty damning.

Did you have to do a lot of research about the healthcare system?

Yes. I come from the U.K. where we have socialized healthcare. It was very new to me to witness a healthcare system where your kid could get leukemia and you lose your home. It was really disturbing to me. My first real interaction with it was in the book and I knew I needed to spend a lot of time really fully grasping it. My instant knee-jerk reaction was, 'This is crazy.'

I worked two weeks of night shifts in a burn unit in Connecticut alongside nurses, shadowing them, listening to them, hearing about their experiences as nurses and as people within these systems. I did a lot of research about how these things are geared and who benefits from it and who doesn't. When you strip it back, you realize it's just people working within systems. They're told this is how it's done, and they move through it. I brought all of that into the script. You've got Kim Dickens’ character, who's based on a real character who did those things. She was a nurse who had a full understanding of what was going on, in my opinion. Then you've got Amy who's on the other end of that. Both of them are working within a system where Amy says, ‘This is wrong. I'm going to work against it.’ To me, that's the takeaway of the film because we're all trapped by certain systems. Do we perpetuate it, or do we go 'f*ck that' and I like that Amy went ‘f*ck that.’

Jessica Chastain as Amy Loughren in The Good Nurse. Photo credit JoJo Whilden / Netflix

Jessica Chastain as Amy Loughren in The Good Nurse. Photo credit JoJo Whilden / Netflix

How long did it take you to do the first draft?

I write pretty quickly so I think I spent maybe three weeks on the very first draft. But then I do a lot of rewriting. I'll build a draft for myself. Then rewrite it three or four times. Then give it to some people I trust, one of who’s my mum, and I'll get initial feedback on what works, what doesn't. Then I'll do another pass, that's one I usually share with producers. I love being collaborative, I really like getting notes. So, I'll do a lot of back and forth with producers. Because it's a true story and you're still trying to satisfy the narrative of films we understand, there was structurally a lot of things we had to work through and put them in places that felt real and true. The drafts are written quickly but the time to get them ready is a couple of months.

What are the challenges of doing an adaptation as opposed to an original script?

If you're doing an adaptation of a fictional book it's very different from adapting a factual book. I shy away from adapting fiction books because the medium is so different from film and there's a different way that readers interact. But with this, this book is almost presented like a court case. Here's the evidence. Here's the supporting evidence. Here is a theory. Here is a conflicting theory. It's presented in a palatable way that I can understand. It felt thrilling but not salacious. 

I suppose tonally what I wanted to achieve was reap the rewards that Charles Graeber had put into his book. The real hard part of doing it is figuring out how to compress the story and focus in on parts of the story. That's a lot of internal discussions. And with your hairdresser. Or the people you meet in the dog park. I find it helpful to have loads of people to talk about this stuff with and bounce it off. People that work in the film industry and people that are miles from this industry but like to watch movies. The audience. 

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Then the other thing is you have to zero in on time. There's a real knack for compressing story while still building character relationships that requires a couple of drafts to fully evolve. Then you're really hoping that you get some great actors. We did all right…an Oscar-winning redhead duo!

Do feel you work differently solo than when you work in a writers’ room?

Not massively. When I'm working solo, I probably talk to myself a bit more. I'll spend a lot of time writing. I'll sit down at 10:00 a.m. and won't stop until 6:00 p.m. without taking a break. In that time period, I'll mostly drink Sprite...! I'll have long bouts of concentrated writing so that I get into a rhythm of it. 

Working with Sam and Edgar was very similar, but they like to stop for lunch. For a while I had to wrestle with that because it would take me out of it. Then it was just a matter of tuning my process with theirs and vice versa. When you debate, you really get to something. Whether I'm working solo or with collaborators, I'm always looking for the debate and who to have the debate with. Sometimes it's me, sometimes it's my dog. To me, the real secret of writing is to just write the terrible first draft. Get it over with and move on from there.

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What's the difference between writing in the U.K. and writing here?

I have to keep taking the 'u's out of a lot of words. I have to remember to say apartment and not flat…! Almost everything I do is for the U.S. I think because I have a scale and ambition that's larger budget and quite far away from theater. A lot of British film used to be theater based and had a different philosophy. We couldn't afford to go to the theater when I was growing up, particularly not in London. All of my understanding of filmmaking was from watching big movies. You write what you dream of doing, don't you? What you dream of doing gets inside you when you're very young. I always wanted to write The Talented Mr. Ripley.

Do you feel you have a genre you prefer?

I love adapting true stories. I love being able to research. When you can get into something that leans slightly into thriller or slightly into action...that's where you take things that are human stories and you push them into movies. I believe at my core that cinema should be entertainment. It can be other things...it should be representation, it should be educational but if it's not entertaining, it can't be any of those other things.

Watch The Good Nurse on Netflix October 26, 2022


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