A tale creepy enough to freeze the blood.
SINCE 1970, more than ninety serial murderers around the world have been convicted after operating in hospitals, long-term care homes, and private residences with elderly charges. Between them, these nurses (mainly) and doctors (a few) have killed or injured over 600 people; an additional 2,600 deaths are connected to them but unproven. The caregiver killer deploys a subtle arsenal of insulin and opiates and pillows over faces. They hasten a person’s demise by doping them with already-prescribed drugs at higher doses, or they induce heart attacks or strokes. Another forty health care workers in this time period evaded conviction for lack of evidence beyond reasonable doubt. In the Gosport War Memorial Hospital, in England, for instance, a female physician presided over 456 deaths due to inappropriate prescribing of opioids between 1987 and 2001, with another 200 patients considered to be her possible victims. Although she was censured for “professional misconduct,” her licence wasn’t even suspended, much less was she prosecuted for manslaughter or murder.
What this means is that we could be talking about 130 suspected serial killers in North America and Europe—dozens of John Wayne Gacys and Jeffrey Dahmers—in the last half century. And these are only the ones known or suspected. There have been other care homes and hospitals with highly suspicious death rates that have never been fully explained. Like the red-light district and the lonely highway, institutional care settings are prime hunting grounds for the modern serial killer.
Aside from the home, these care homes and hospitals are also the main source of victims for women who kill. We don’t fully understand what separates these women from others of their gender. But more than half of health care serial killers are female, according to Southern California University nursing professor Beatrice Crofts Yorker. By that measure, there have been at least forty-five of them in the years since the FBI established its Behavioral Science Unit at Quantico, the subject of Netflix’s Mindhunter—even though the leaders of the unit declared to this author personally that all serial killers were male.
In 2015, psychologist Marissa Harrison and a group of women colleagues published a review of female serial killers that found they “tend to carry out their crimes over a longer period of time, have more victims . . . are frequently nurses or serve some other caretaker role.” They choose “victims who had little or no chance of fighting back.” The FBI’s Behavioral Science Unit may not have noticed it, but the phenomenon is hardly new. In the nineteenth century, American nurse Jane Topping confessed to thirty-one murders of patients in Massachusetts. In England, nurse Catherine Wilson was caught poisoning her frail charges in the 1850s and 1860s. In the early 1900s, Amelia Sach and Annie Walters ran an adoption business in the UK, but instead of rehoming the babies, they smothered or poisoned them; the total number of victims was thought to be in the dozens. Amy Archer-Gilligan, born one Halloween night in the late nineteenth century, murdered husbands to cash in life insurance policies that financed the nursing homes she ran, whose residents she poisoned. (In popular culture, her crime spree sparked a comedic play, Arsenic and Old Lace, which nicely sums up the difference in how we regard serial killers by gender.)
In July 2018, a British health care worker was arrested on the suspicion that she had murdered eight babies and tried to kill six others while she worked at the Countess of Chester Hospital, in northwestern England. Days later, there were reports that a Japanese nurse had been arrested on the suspicion that she’d injected disinfectant into intravenous bags, killing approximately twenty elderly patients in her care at a Yokohama hospital. So, this subgenre of serial murderer continues to flourish. The question worth asking ourselves is whether we aren’t looking for such killers because we don’t truly value their victims or because we cannot abandon the image of nurturing women.
I long ago developed something of an interest in the serial-murder aberration, and have read up on it a fair-ish bit over the years. Because of that, I knew already that the widespread perception of serial killers being almost exclusively white males afflicted with some kind of crippling sexual disorder, psychological or physical, is complete baloney. There are also vitally important distinctions to be made between serial killers, spree killers, and mass murderers which are ignored as a rule, except among homicide investigators, crime scene techs, and other folks who specialize in such dreadful matters.
The reality is that there have always been many more active serial killers prowling the land for prey than any of us would prefer to believe, and that although there are some commonalities to be found among ’em, the absence of reliably hard and fast markers such as gender, ethnicity, income, or intellectual capacity makes them extremely difficult to identify and apprehend. Which is why most of them…aren’t. It might not be entirely accurate to call the awful story of Madison, Wisconsin’s Capital City Killer* a typical one. But it wouldn’t be entirely accurate to say that it isn’t, either.
The only assumption it’s ever safe to make as to what ingredients are essential in the making of these monsters is a complete lack of empathy for the victims—an absence confirmed by the offense itself, rendered supremely useless for investigative purposes by its painful obviousness. Contrary to the common notion that serial killers are social maladroits who find normal, casual interaction with others all but impossible, they’re often quite charming and personable people. As the old saying goes: Ted Bundy didn’t have horns and a tail.
All in all, the facts paint a pretty scary picture for us. Serial killers aren’t necessarily easy to identify, which likewise makes it easier to become ensnared by them. Not all of their victims are stupid, unobservant hookers, intoxicated homeless people, or naive waifs. The escalating intensity of the urge to kill that drives a serial killer creates in them a persistence and single-mindedness when on the hunt that can sometimes be the only way to recognize and avoid them. The line between sensible caution and absurd paranoia is one the serial killer finds easy to blur or erase in their intended victims, a skill honed by a lifetime of manipulation, concealment, and deception. The penalty for failure to keep to the right side of that line is ordinarily an argument, maybe even an ugly end to a formerly treasured relationship. With a serial killer, though, the penalty for not paying strictest attention to the line is death.
* A soulless fiend identified only after an arduous forty-year pursuit by an early victims’ closest friend and fellow UW-Mad student, Linda Tomaszewski. He was never apprehended or tried mainly due to police corruption, bungling, disinterest, and intentional cover-up, and the case is still officially unresolved. The killer’s journey begins in Africa with the massacre of an entire tribal village, the bloody opening act of a nightmarish carnival of death whose decades-long run closed only after a US tour spanning the entire continent. It’s one of those stories marred by a most unsatisfactory ending: the demonic protagonist dies peacefully in his bed at a ripe old age, smugly taunting Tomaszewski with tacit acknowledgment of his guilt, unmolested by the hand of justice to the last. And yes, he was also a doctor, as it turns out. Go figure.
An aside: the book linked on the other end of the asterisk (Mad City: The True Story of the Campus Murders That America Forgot) is a meticulously-researched, somewhat scholarly account written by a former LEO and criminologist, for any of you weirdos who might share my interest in this admittedly unsettling topic. It might be a bit dry for some tastes, but to me the absence of leering prurience or melodrama is a good thing. YMMV, as always, but I really enjoyed it myself. For an even deeper dive into this darkest of pits, I also recommend the free download (in PDF) of the FBI’s seminal 2008 report Serial Murder: Multi-Disciplinary Perspectives for Investigators, which is universally hailed even today as the most thorough and useful study yet undertaken on the behavior, methods, and motivations of these enigmatic predators.