SERIAL KILLER: The Killer Nurse Pt. 2

Summary

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Killer Minds: Serial Killers & True Crime Murders

Episode: SERIAL KILLER: The Killer Nurse Pt. 2

Hosted by Vanessa Richardson and Dr. Tristin Engels
Date: November 6, 2025

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Episode Overview

In this gripping conclusion to their two-part series on Charles Cullen—dubbed “The Killer Nurse”—hosts Vanessa Richardson and forensic psychologist Dr. Tristin Engels dive deep into the darkest chapters of Cullen’s prolific killing spree. The episode examines not only Cullen’s methods and psychological profile but also lays bare the systemic failures that allowed him to become one of America’s most prolific serial killers. Through chilling storytelling and layered psychological analysis, they piece together how Cullen rationalized his crimes, manipulated those around him, and ultimately, what finally brought him to justice.

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Key Discussion Points & Insights

1. Cullen’s Escalating Crimes and Methods

(04:51–08:18)

• Career as Revenge: Charles Cullen, working as a skilled nurse, quietly sought revenge on the medical system by secretly poisoning patients, believing himself justified and superior to his peers.
• Notable Victim (Helen Dean): In 1993, Cullen injected 91-year-old Helen Dean with digoxin—a powerful heart medication—leading to her death; the drug was undetectable in a standard autopsy.
• Systemic Failures: Despite suspicions, the hospital placed him on paid leave but ultimately let him go, giving him a glowing reference to avoid scandal.

“Charles did that by secretly poisoning patients, leaving his co-workers to wonder what had gone wrong... He could kill with impunity, and that’s exactly what he did.”
– Vanessa Richardson (09:36)

2. Psychological Analysis: Methodical Escalation

(08:18–09:36)

• Dr. Engels describes Cullen’s evolution as “methodical escalation,” highlighting how he refined his methods to avoid detection and weaponized the inherent trust of his caretaking role.

“He’s weaponizing trust to settle his own grievances and self hatred. And that’s one of the most chilling parts about this.”
– Dr. Tristin Engels (08:18)

3. Manipulation, Control, and Exploiting Systemic Gaps

(09:36–12:05)

• Cullen moved across hospitals, each time leaving behind a trail of death but escaping scrutiny due to lack of evidence. He repeatedly used obscure drugs or withheld treatment, outpacing any system designed to flag suspicious activity.
• Otto Schram (Victim): Cullen’s manipulation extended to attempting to dissuade grieving families from ordering autopsies on his victims.

“What he did here with Christina is very cold and calculating. And it’s about damage control and domination... weaponizing grief, which is truly ruthless manipulation and a marker of predatory intent.”
– Dr. Tristin Engels (12:05)

4. Personality Traits and Psychological Disorders

(12:48–13:37)

• Dr. Engels explores the likely personality disorders at play:
  • Callousness, lack of empathy, manipulation, superficial charm, entitlement, and predatory violence.
  • Cullen had a history of depression, alcohol dependence, and suicidal behavior, possibly showing traits of antisocial, narcissistic, and borderline personality disorders.

5. Red Flags and Hospitals’ Willful Blindness

(13:37–17:57)

• Hospitals often suspected Cullen but chose to avoid responsibility by quietly letting him go with positive references.
• Even when suspicious deaths and drug tampering were identified—such as moving to use vecuronium, leaving evidence in hospital supply rooms—Cullen evaded consequences, underscoring a systemic culture of denial and protectionism.

6. Psychological Downturn and a Suicide Attempt

(17:57–19:44)

• After overhearing fellow nurses express relief that a victim (Matthew Maddern) was no longer suffering, Cullen made a serious suicide attempt, possibly triggered by a sense of social permission or psychological mirroring.

“Hearing those nurses normalize death as relief... may have reignited the core belief that he could end his own suffering through death and in some way given him social permission to act on himself.”
– Dr. Tristin Engels (17:57)

7. Cullen’s Boundary Testing and Drama Triangle

(19:44–23:25)

• Cullen began manipulating his public image—playing the “hero” after poisoning patients, staging pranks, and inventing fake secret admirers (the “Brian Flynn” ruse), all attempts at attention-seeking and boundary-pushing.
• Dr. Engels explains Cullen’s actions through Karpman’s “drama triangle”: perpetrator, rescuer, victim—roles which allowed him to control narratives and elicit sympathy.

“Charles, playing hero after poisoning seems to fit this. He’s creating the crisis by being the perpetrator who controls it, then steps in as the rescuer to save them... And as the rescuer, Charles gets attention and approval.”
– Dr. Tristin Engels (21:45)

8. The Friendship with Amy Loughran

(24:31–30:19)

• At Somerset Medical, Cullen befriended nurse Amy Loughran, bonding over mutual trauma and chronic illness. This friendship allowed him to blend in but also became an avenue to test her loyalty—he risked her safety by supplying stolen medication.

“People like Charles can form relationships that look like friendship, but are often superficial and fragile... he very quickly tested her boundaries and put her at risk.”
– Dr. Tristin Engels (28:36)

9. The Final Investigation & Cullen’s Arrest

(30:19–43:40)

• As patient deaths mounted, Somerset finally contacted authorities; nurses, Poison Control, and law enforcement slowly pieced together Cullen’s pattern—hindered by former hospitals’ reluctance to share employment details.
• Police exhumed a victim and set a trap, ultimately relying on Amy Loughran’s pivotal role. She confronted Cullen while wired for audio; his vague admissions secured his arrest.

“All Charles said was that he wanted to, quote, go down fighting.”
– Vanessa Richardson (40:51)

10. The Confession and Aftermath

(43:40–48:22)

• In police custody, Cullen displayed regressive, child-like behaviors during interrogation, ultimately confessing his crimes to Amy.
• Facing a potential death penalty, Cullen cooperated—helping investigators compare records and admit to at least 40 murders, though some experts believe the toll could be as high as 400.

“Offenders often offer acceptable motives to reduce shame, frame perceptions, or gain legal advantage. Sometimes they truly do believe their own rationalizations, as I think Charles likely does.”
– Dr. Tristin Engels (47:05)

• Motive remains ambiguous; “mercy” was likely a self-serving rationalization. Revenge, control, and predatory satisfaction were the true drives.

11. Systemic Changes: The "Cullen Law"

(48:22–End)

• Cullen’s case led to new laws—hospitals are now required to report wrongdoing or risk-factors in staff. Pharmacy dispensing machines (Pyxis) now have added security to prevent similar access and tampering.

“One small measure of comfort came from Charles’s crimes. In 2005, the state of New Jersey passed what’s now known as the Cullen Law, which ensures medical professionals report on unsafe or unauthorized behavior.”
– Vanessa Richardson (48:22)

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Notable Quotes & Memorable Moments

• On Medical System Complicity:
  “He could kill with impunity, and that’s exactly what he did. For the next five years, Charles repeated this same routine... Every hospital suspected he had done it on purpose, but no one could prove it.”
  — Vanessa Richardson (09:36)

• On Methodical Escalation:
  “Choosing digoxin means he’s exploiting gaps in toxicology so deaths appear medically plausible or at least ambiguous... It’s certainly a refinement of his methods, but it’s also increased confidence and boldness.”
  — Dr. Tristin Engels (08:18)

• On Predatory Manipulation:
  “He is able to mask his predatory behavior behind a caregiving role, one that is inherently trusted by most people.”
  — Dr. Tristin Engels (08:18)

• On Motive:
  “Mercy was a rationalization, one that allowed him to continue his actions. But revenge, control and predatory behavior were very likely the driving forces.”
  — Dr. Tristin Engels (47:19)

• On Systemic Change:
  “One small measure of comfort came from Charles’s crimes... The Cullen Law, which ensures medical professionals report on unsafe or unauthorized behavior.”
  — Vanessa Richardson (48:22)

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Episode Timeline & Timestamps

| Timestamp | Segment | Description | |-----------|---------|-------------| | 04:51–08:18 | Helen Dean’s Murder & Hospital Response | Setup of Cullen’s methods, poisoning, and systemic failures | | 08:18–09:36 | Psychological Analysis: Escalation | Dr. Engels on Cullen’s criminal sophistication | | 09:36–13:37 | Pattern Repeats: Hospital Moves & Manipulations | New victims (Otto Schram), hospitals’ recurring protection of Cullen | | 13:37–17:57 | Red Flags Ignored & Onset of Decline | Hospital suspicions, manipulation, reaching a breaking point | | 17:57–19:44 | Suicide Attempt & Psychological Triggers | The impact of external validation on self-harm | | 19:44–23:25 | Behavioral Escalation: Pranks & Drama Triangle | Hero/victim/perpetrator cycles, attention-seeking via pranks | | 24:31–30:19 | Amy Loughran: The Fragile Friendship | Amy’s role, Cullen’s boundary testing, and trust exploitation | | 30:19–34:29 | The Investigation Tightens | Pyxis exploitation, hospital and police cooperation | | 36:29–43:40 | Arrest & Confession | The trap is sprung, confession to Amy, legal consequences | | 43:40–48:22 | Motive Explored & Systemic Consequences | Dr. Engels on motive, new laws, and policy changes |

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Conclusion

This episode offers a thorough, unflinching exploration of Charles Cullen’s crimes—painting a picture not only of a coldly methodical killer but of a healthcare system that too often chooses liability protection over patient safety. Vanessa Richardson’s storytelling, paired with Dr. Tristin Engels’ expert clinical insights, examines motives that blur the line between mercy and revenge, empathy and predation. The aftermath—including the passage of new laws and hospital reforms—reminds listeners not just of the horror, but of the lessons learned and the safeguards now in place.

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For listeners, this episode is a chilling reminder of how power, trust, and institutional denial can intersect with lethal consequences—and how, ultimately, justice and change can prevail, even if far too late for many victims.

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Transcript

[Vanessa Richardson]

Hi Crime House community. It's Vanessa Richardson. And if you love digging into the most gripping true crime stories, then you need to listen to another Crime House original. Crimes of with Sabrina Deanna Roga and Corinne Vien. Crimes of is a weekly series that explores a new theme each season from Crimes of Paranormal, unsolved murders, mysterious disappearances, and more. Sabrina and Corinne have been covering the true stories behind Hollywood's most iconic horror villains and and this month they'll be diving into the paranormal. Listen to Crimes of every Tuesday on Apple Podcasts, Spotify, Amazon Music or wherever you listen to podcasts. This is Crime House. We all rationalize bad behavior sometimes, from the little white lies to the bigger transgressions. It's human to want to believe you're in the right. And most of us realize our mistakes eventually. But not Charles Cullen. He believed his actions were always justified, even when it came to murder. Throughout the late 80s and 90s, Charles used his position as a nurse to kill countless patients. He became known as the most prolific serial killer in American history. And he did it all with no remorse. The human mind is powerful. It shapes how we think, feel, love and hate. But sometimes it drives people to commit the unthinkable. This is Killer, A Crime House original. I'm Vanessa Richardson. Richardson.

[Dr. Tristan Engels]

And I'm Dr. Tristan Ingalls. Every Monday and Thursday, we uncover the darkest minds in history, analyzing what makes.

[Vanessa Richardson]

A killer Crime House is made possible by you. Please rate, review and follow Killer Minds to enhance your listening experience with ad. Free early access to each two part series and bonus content. Subscribe to Crime House plus on Apple Podcasts. Before we get started, be advised. This episode contains discussion of abuse, depression, suicide and murder. Today we conclude our deep dive on Charles Cullen, a killer nurse who believed he had the right to choose which patients lived and which ones died. Despite his evil deeds, Charles slipped through the cracks in the system for years. Eventually he'd go on to make history as one of America's most prolific serial killers.

[Dr. Tristan Engels]

As Vanessa goes through the story, I'll be talking about things like how some killers rationalize acts of violence and how they manipulate others in their day to day lives. And why killers don't always provide a clear motive.

[Vanessa Richardson]

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No purchase necessary VGW Group void board prohibited by law 21/TNCs apply by 1993, 33 year old Charles Cullen had been working as a critical care nurse for almost a day decade. His career was the most important thing to him because it was where he sought revenge for all the harm he felt medical workers had caused him in the past. Charles was extremely skilled at his job and he used his abilities to covertly prove his belief that other staff members were incompetent and didn't actually care about their work. Charles did that by secretly poisoning patients, leaving his co workers to wonder what had gone wrong. He had pondered poisoned countless people and killed at least one, a man named John Yango who died five years earlier in 1988. Charles's need for control only grew after his wife divorced him and he was charged with harassing and stalking a co worker in the early 90s. So he began searching for his next victim. In the fall of 1993, Charles was still working at Warren Hospital in Phillipsburg, New Jersey. On September 1st of that year, 91 year old Helen Dean was resting after surgery. She was expected to make a full recovery, but Charles had other plans for her. That day he walked into Helen's room and told her he Was there to administer a scheduled injection. That didn't sound right to Helen, But Charles told her it would be quick and painless. And his confidence seemed to sway her because she finally agreed. Charles inserted the needle into Helen's thigh. Then he walked out of the room. Shortly after, Helen's son Larry arrived for a visit. When Helen told Larry that a nurse had given her something, he was suspicious, too. So he asked Helen's doctor about it. But the doctor didn't see any scheduled injections in Helen's chart. He told Larry she must be confused. The doctor had no idea that Charles had injected Helen with a drug called digoxin, A powerful heart medication. When given to someone who doesn't need it, digoxin can cause dangerous and even fatal cardiac arrhythmias. Which is exactly what happened to Helen shortly after, Charles injected her. And unfortunately, she didn't survive. Larry was outraged. He knew the nurse who visited his mother had done something wrong. So he immediately contacted the county prosecutor's office to report that his mother had been killed by a nurse named Charles Cullen. When Charles showed up for his next shift, hospital administrators and police officers pulled him aside for questioning. Charles kept his cool and told them he had done nothing wrong. He was banking on the fact that digoxin was too obscure of a drug to show up in Helen's autopsy results. Medical examiners didn't usually screen for it. And he was right. Helen's autopsy didn't show signs of any wrongdoing. The ME Said her death was the result of no natural causes. Still, administrators at Warren hospital suspected Charles was behind it. According to Charles, they knew he was potentially dangerous, so they placed him on paid leave while they continued to investigate internally.

[Dr. Tristan Engels]

This is methodical escalation. He didn't stumble into a better poison. In his mind. He learned from earlier cases that insulin could be detected on routine labs, and then he adapted. This is not unlike how most serial offenders escalate. It's just being done in a professional, general setting. Choosing digoxin means he's exploiting gaps in toxicology so deaths appear medically plausible or at least ambiguous. And that pattern reflects planning and premeditation. It also reveals criminal sophistication because it's evidence of calculated timing, deliberate victim selection, a charm to gain trust, like he did with Helen, and the tactical use of his role to avoid detection, or at least attempt to. It's certainly a refinement of his methods, but it's also increased confidence and boldness. And what makes him especially dangerous is that he is able to Mask his predatory behavior behind a caregiving role, one that is inherently trusted by most people. He is tasked with caring for people during their most vulnerable moments, but instead sees them as an opportunity to prey upon for his own control, revenge and gratification. He's weaponizing trust to settle his own grievances and self hatred. And that's one of the most chilling parts about this.

[Vanessa Richardson]

Well, to Charles, being placed on leave was almost laughable. He was basically on paid vacation. And after a few months, Warren hospital still couldn't prove anything. All they could do was keep him out of their hair for good. If they couldn't stop him from killing altogether, they could protect their own patients and their own reputation. So they let him go, but wrote glowing employee reviews for Charles as a way to make him someone else's problem. This told Charles everything he needed to know about the hospital system. Administrators cared more about themselves than their patients. He could kill with impunity, and that's exactly what he did. For the next five years, Charles repeated this same routine. He worked at a total of three hospitals, Two in New Jersey and one in nearby Pennsylvania. And he killed a total of four patients that we know of. Each time he either used digoxin or Insul. In a couple of instances, he killed them by withholding medications instead. Every hospital suspected he had done it on purpose, but no one could prove it. So his employment records never stopped him from moving on to new hospitals. However, Charles soon became too confident in his schemes. In November 1998, Charles got a new job at the Easton Hospital ICU in Pennsylvania. About a month later, a 78 year old patient named Otto Schramm was admitted after suffering a Seizure. Sometime between December 28 and December 31, Charles slipped into Otto's room and injected him with digoxin. Otto's blood pressure dropped suddenly. His doctor ordered lab work which would later show high digoxin levels. But this discovery came far too late. By the end of the day, Otto was dead. The doctor was confused and suspicious. After consoling Otto's daughter Christina, he told her she should request an autopsy. Later in the day, Charles caught wind of this. He knew that since the doctor had found digoxin in Otto's system, the medical examiner would test for it specifically. It wouldn't be like Helen Dean's death when no one had any idea what to look for. So Charles approached Christina and tried to persuade her not to do an autopsy. He said her father would not have wanted to be cut open.

[Dr. Tristan Engels]

What he did here with Christina is very cold and calculating. And it's about damage control and domination. Obviously, he wants plausible deniability. That is the basis in which he builds his methods around. And discouraging an autopsy preserves plausible deniability. For him, speaking directly to Christina was his way of also testing his influence. He engineered and he attempted to frame events to his advantage. Psychologically, this indicates that he can witness someone's physical and emotional pain and simultaneously treat it instrumentally, which we have seen a pattern of. Only now he's weaponizing grief, which is truly ruthless manipulation and a marker of predatory intent.

[Vanessa Richardson]

What types of personality or psychological traits are on display here?

[Dr. Tristan Engels]

Okay, so I've never met nor evaluated Charles. So this is not a formal clinical opinion or diagnosis and is for educational purposes only. But the traits we are seeing here are callousness, lack of empathy, manipulation and exploitation, superficial charm, entitlement, moral disengagement, and instrumental and predatory violence. He also has a reported history of chronic depression, alcohol dependence, suicidal behavior, attachment deficits, and emotional blunting. If I was assessing someone with these traits, in addition to mood disorders and substance use disorders, I would rule out antisocial personality disorder, narcissistic personality disorder, and borderline personality disorder.

[Vanessa Richardson]

Well, Charles behavior was highly inappropriate. And when the rest of Otto's family heard about it, they thought so, too. They convinced Christina to go ahead with the autopsy. Ultimately, the medical examiner confirmed that Otto had suffered a digoxin overdose. But just like at Warren in Easton, Hospital didn't want a scandal. So Charles faced zero consequences. However, he knew he was on thin ice, so he decided to leave on his own. And By March of 1999, he was working in the burn unit of Lehigh Valley Hospital in Pennsylvania. Almost right away, other staff members started noticing an alarmingly high rate of codes, which is when a patient suddenly flatlines. Pretty soon, they connected things to the arrival of new hire Charles Cullen. And months later, the pattern became impossible to ignore. In August of 1999, a patient in his early 20s named Matthew Maddern was admitted to the unit with extreme burns he sustained in a car accident. Doctors believed Matthew had just a 10% chance of survival. The staff was saddened by the news, but Charles didn't believe their pity was real. And he wanted to show them what happens when they pretend to care. August 31, Charles injected Matthew with digoxin. Matthew was dead by the end of the day. After he passed, Charles overheard some nurses say they were at least glad Matthew was no longer suffering. Hearing their comments seemed to trigger something in Charles, and it made him do something he never expected. Starting your own business can be exciting, but let's be real. It's also intimidating. You're juggling a million tasks, wondering if you have what it takes, and probably asking yourself what if it doesn't work out? Shopify powers millions of businesses worldwide and 10% of all e commerce in the US from household names like Mattel and Gymshark to brands just starting out. No big team, Shopify handles everything from website design to inventory, customer service and global shipping marketing on a budget. Shopify's built in email and social tools help you find new customers and keep them selling in person. Their award winning point of sale connects your online and offline sales seamlessly. Want to go global? Shopify lets you sell in over 150 countries with tools that handle translations, shipping and more. With 99.99% uptime and the best converting checkout on the planet, you'll never miss a sale again. Turn those what ifs into and keep giving those big dreams the best shot with Shopify. Sign up for your $1 per month trial and start selling today at shopify.com serial killer. Go to shopify.com serialkiller shopify.com serialkiller avoiding your unfinished home projects because you're not sure where to start? Thumbtack knows homes so you don't have to don't know the difference between matte, paint, finish and satin or what that clunking sound from your dryer is. With thumbtack, you don't have to be a home pro, you just have to hire one. You can hire top rated pros, see price estimates and read reviews all on the app. Download Today. In August of 1999, 39 year old Charles Cullen killed a burn unit patient at Lehigh Valley Hospital Hospital. Afterward, he overheard other nurses saying they were grateful the patient was no longer suffering. For some reason, these comments got to Charles. We don't know whether he targeted any more patients over the next few months, but his mental health had taken a nose dive like never before. Charles's depression was eating away at him and on January 3, 2000, Charles did something drastic. That day, Charles tried to take his own life by carbon monoxide poisoning. It wasn't like his previous attempts when he used pills and alcohol. Charles seemed intent on dying and this.

[Dr. Tristan Engels]

Was a very serious attempt, which is markedly different from his previous ones, which seemed staged or were not likely lethal, which suggested ambivalence or secondary gain. Whereas this appeared intentional, it required planning and it had a reduced desire for being rescued. And it can be very lethal. This is significant, but it's what triggered him that I find also significant. And like you outlined Vanessa, it happened after he killed Matthew and he has killed multiple people by now and this has not caused him to make a serious attempt like it has in the past. What makes this seemingly different is overhearing the nurses comment that they were happy his victim Matthew wasn't suffering any longer. Let's recall from episode one that Charles attempted to take his own life when he was a juvenile to end his own suffering and he justified his current murders in the same way. Hearing those nurses normalize death as relief. Which seems like the first time this may have happened, or at least the first time it's been mentioned in the story. That may have reignited the core belief that he could end his own suffering through death and in some way given him social permission to act on himself. Clinically, we call that suicide contagion or social modeling. At the same time, he may have wanted the same response if he was successful, which is sympathy or vindication, which is a form of mirrored recognition tied to entitlement and grievance. It would be hard to truly know what motivated him in this moment, especially without a suicide note or without Charles to actually tell us himself. But both pathways actually fit his profile of habitual self harm, escalating capability, and his need for control and validation.

[Vanessa Richardson]

Whatever Charles's reasoning was, his plan didn't seem to go as expected. His landlord smelled the fumes and called 91 1. First responders quickly arrived and resuscitated him. Just a few months later, In April of 2000, 40 year old Charles was ready to return to work. But he didn't go back to Lehigh Valley. This time. He got a job at a facility called St. Luke's at the time, a nationwide nurse shortage made it easy to find work. The hospital even gave Charles a $5,000 signing bonus. Almost as soon as he began his shifts, more patients than usual began to code. But Charles also made a big change to his mo. Now, whenever patients crashed, Charles put on a hero act by racing into the room and throwing himself into chest compressions. It seemed to work. Charles's co workers were grateful and impressed. Charles realized how much he enjoyed putting on this show. And that wasn't the only game he liked to play with his colleagues. After almost every shift, Charles would stay late and when no one was around, he moved around the furniture from the nursing station into different rooms. He liked seeing his co workers confusion and annoyance every time he did this. Soon Charles took his pranks a step further. By February of 2001 he had a crush on another nurse named Julie. Charles started leaving Julie gifts at the nurse's station like flowers and candy. But instead of signing his own name, Charles signed the name Brian Flynn. It seems like this alias was random. There was no Brian Flynn at the hospital. Hospital. Charles did this partly to spark gossip and intrigue, which worked for a few weeks. Once he had created enough buzz, Charles decided it was time to tell Julie he was Brian Flynn. But Julie wasn't flattered or amused. She was creeped out.

[Dr. Tristan Engels]

Those pranks and the Brian Flynn stunt are classic boundary testing and attention seeking behaviors. Clinically, they serve several functions at once. They create gossip and social focus. They allow him to experimen influence, and it normalizes being the center of attention without having to risk any kind of genuine intimacy. The alias is a manipulation technique. It creates curiosity and gives him control over how others interpret him. Now let's discuss the fact that he plays hero to the people he poisons. There's something called Cartman's drama triangle, which we commonly see occur with personality disorders. This is when someone takes on three roles. The victim, the perpetrator, and the rescuer. Charles, playing hero after poisoning seems to fit this. He's creating the crisis by being the perpetrator who controls it, then steps in as the rescuer to save them, which reinforces that the victim whom he is poisoning cannot survive without him. And as the rescuer, Charles gets attention and approval. However, whenever his motives are questioned, which they have been in the past, he seems to the victim role himself. And in some instances that included suicidal gestures to gain sympathy and validation. And in those instances, he is seeking rescue by someone else. And that is the drama triangle, which explains why he often made gestures where intervention was likely or drove himself to the very hospital that he was let go from. And if you think about it, this started long ago, back even when he was in the Navy.

[Vanessa Richardson]

What motivates Charles to get a rise out of people through pranks like moving furniture? I know people like that. And also, why did he toy with Julie for so long?

[Dr. Tristan Engels]

Well, he's getting psychological gratification from that. These behaviors are manufacturing attention. It's testing boundaries, and it's making him feel powerful without any real overt risk. With Julie, it's a fixation similar to the one we saw with Michelle and that we talked about in episode one. It presents like fantasy rehearsal, entitlement and a refusal or maybe even an innovation ability to accept normal social rejection. The alias and the gifts allow him to interact anonymously on his terms and Keep her, Julie, emotionally engaged or off balance. And together, these behaviors, they're manipulative, they show poor impulse control and a fragile sense of self worth. These are traits common in personality pathology. Again, if I was to evaluate someone similar with these traits, I would look for antisocial, narcissistic, and borderline personality disorders.

[Vanessa Richardson]

After Julie's rejection, Charles stopped trying to impress and amuse people. Instead, he wanted to scare them. On June 1, a pharmacy runner dropped off the drug cart for the night shift. Typically, it was the runner's job to stock the medical supplies and drugs, But Charles offered to do it instead. He took the cart into the medical supply closet. It locked the door and began tampering with IV bags. This time, he spiked them with vecuronium, known as vec for short, which is a powerful paralytic. In high enough doses, it can cause a person to suffocate. From there, he intentionally left all the used vec needles and empty boxes in the biohazard waste bin in the closet. Two days later, one of his co workers, a nurse named Kim, was found them. Kim was alarmed, so she checked patient records for the entire unit and saw that nobody had been prescribed vec that weekend, Kim took her concerns to another nurse on staff. That same day, they took turns watching the med closet for any suspicious activity. They didn't see anything until the night shift rolled around. That's when they spotted Charles slip into the closet and stay in there for a suspicious amount of time. And when he left, Kim went inside and checked the waste bin. It was suddenly full again. Now she knew Charles was the culprit. Kim alerted the hospital risk manager, who quickly alerted a team of lawyers. The next time Charles came to work, they questioned him. He denied any wrongdoing. According to Charles, things played out the same way they always had. The hospital knew their evidence against him was only circumstantial. So instead of letting a massive scandal unfold, they cut Charles a deal. If he resigned now, they would give him references for future jobs. Charles accepted their offer, and the whole thing was swept under the rug. At the same time, the damage there had already been done. But it was hard to know how many patients Charles had killed, if any, because the only way to know would be to test every single patient who recently passed away. And it doesn't seem like the hospital had the time or the resources to do that. Meanwhile, Charles got a new job. That same week, he began working at Sacred Heart hospital in Allentown, Pennsylvania, just down the road from St. Luke's things started off well. But soon his reputation caught up to him. A nurse from Easton Hospital, where Otto Schram had died, told staff at Sacred Heart about the Dejon toxin rumors that had surrounded Charles. Once they heard this, the staff at Sacred Heart threatened to quit unless Charles was fired. The hospital listened, and Charles lost his job almost as soon as he got it. But it's unknown if they alerted other hospitals about him. So In September of 2002, 42 year old Charles began working at Somerset Medical center in New Jersey. Charles fit right in at Somerset. He was punctual, helpful, and well liked from the start. And he became fast friends with a nurse named Amy Loughran. On the surface, Charles and Amy were opposites. She was outspoken and brash, while Charles could be quiet and reserved. But as they got to know each other, they bonded over their shared histories of child abuse. Their bond grew stronger when Amy shared a secret. She had cardiomyopathy, a serious heart condition that produces symptoms that can trigger panic attacks. None of their other co workers knew, and Charles promised to keep her secret. Then one day at work, Charles noticed Amy struggling to breathe. He swiped some pills and gave them to Amy to help her feel better. To Amy, it seemed like this was the first time Charles had stolen medication and that he'd done it it just for her.

[Dr. Tristan Engels]

In my clinical view, people like Charles can form relationships that look like friendship, but are often superficial and fragile. He can appear to be warm, attentive, and even bond over shared trauma, at least enough to create the appearance of closeness. But his history of attachment disruption, emotional numbing, and of course, instrumental harm means the friendship is probably only important as long as it's functional. In this case, Charles was trying to find a new place of employment. People banded together to have him fired, and that was a lot of rejection at once. Amy soothed his loneliness and allowed him to blend into his new job. As a result, his relationship with Amy could have felt very real to him. But then he very quickly tested her boundaries and put her at risk. Risk by giving her stolen pills? That's not a stable reciprocal friendship.

[Vanessa Richardson]

And how might this situation with Amy have validated his rule breaking behavior in terms of how he stole the medicine for her?

[Dr. Tristan Engels]

Well, if you think about it, this is the same validation he has been using. The majority of his past criminal behavior has been to, quote, end suffering. And he framed it as justified, rational or merciful. So when he saw Amy struggling to breathe, he once again saw himself as the solution to suffering. Also beyond helping, by giving Amy stolen medication. This could have been a covert relational Experiment or test? Would she accept him fully despite his rule breaking? Would she keep this secret? Would she collude with him not because he genuinely wants her friendship, or maybe he does, but because he's testing the limits of her functionality or the limits of their attachment.

[Vanessa Richardson]

Still, friendship wasn't enough to convince Charles to stop killing. If anything, he got more creative. Instead of storing medication in a supply closet, Somerset had something known as a Pyxis machine. Nurses could type orders into the machine, then a drawer would pop open to dispense the medication. It was a simple system, and Charles figured out how to exploit it. He'd type in an order, take the drug he wanted, then quickly cancel the request, making it look like a simple mistake. No one ever checked into inventory, which meant no one noticed when dangerous drugs went missing. Charles started doing this on a regular basis, and By June of 2003, he killed seven patients with either insulin or digoxin. But even though Charles's pyxis orders didn't raise red flags, the suspicious deaths did. By the eighth likely fatality, a man named Florian Gaul, the hospital hospital ran post mortem blood work and discovered high levels of digoxin in Florian's system. Hospital administrators quietly reached out to the New Jersey Poison Control, who urged them to alert the authorities. But just like so many hospitals before, Somerset reportedly didn't follow the advice from poison control. Instead, they listed the deaths as accidental. However, the people at Poison Control Patrol refused to let it go. In October of 2003, they asked the Somerset county prosecutor to look into the situation. Four days later, detectives Tim Braun and Danny Baldwin sat down with the hospital's lawyers, and they handed over a list of six unexplained deaths. And now that the authorities were officially involved, the hospital administrators admitted that they were suspicious of a nurse named Charles Cullen. The detectives visited a records clerk and asked to see Charles's file. That's when they Learned about his 1993 harassment and stalking charges. But that wasn't all. The clerk also mentioned that there was a yellow sticky note attached to the folder with one word written on it. Digoxin. As it turned out, a nurse at Easton Hospital had had alerted authorities about Otto Schram's strange death in 1999. Police looked into it at the time, but their investigation didn't go anywhere. That yellow sticky note on Charles's file was the only clue that remained. Detectives Braun and Baldwin were floored that Charles had been able to keep finding work. But most importantly, they knew they had their guy. Now they just had to prove it. To do that, they they first had to compile Charles's full employment history so they could ask other hospitals about his time there. However, none of Charles's former employers were willing to hand over their files on him, which told the detectives one thing. Whenever Charles left a hospital, administrators might have scrubbed his records, likely to avoid future lawsuits. Braun and Baldwin had to keep digging. Meanwhile, Charles was still working. By now he knew eyes were on him, so he switched up his methods and began using a drug called dobutamine, another heart medication that's deadly in high doses. Charles was killing non stop, but the detectives still didn't have anything tying patient deaths back to him. Eventually, they realized what they really needed was a body. Detectives would have to exhume a victim, and they settled on Florian Gaul, who Charles had killed four months earlier. But first they needed his family's permission. That decision fell to Florian's sister, and she agreed right away. It was a crucial step forward, but authorities needed more to nail Charles for good. So they set a trap. Trap. One that Charles never expected to walk into.

[Dr. Tristan Engels]

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[Vanessa Richardson]

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[Vanessa Richardson]

In 2003, 43 year old Charles Cullen was under investigation. Detectives Tim Braun and Danny Baldwin were eyeing Charles as the culprit behind a string of patient deaths, not just at Somerset Hospital in New Jersey, but multiple hospitals across the state and in Pennsylvania. In October of that year, authorities exhumed the body of one of his former patients, Florian Gall, who Charles had killed with Digoxin. While investigators waited for the results, Charles's behavior became even more calculated. The hospital had begun its own internal investigation. On top of questioning nurses, Charles assumed they were monitoring Pyxis records. So he started ordering and withdrawing high amounts of everyday drugs like Tylenol, likely to clutter his own logs and make it harder for them to prove he was doing anything wrong. By doing this, Charles realized he didn't need to create and cancel cancel orders for life threatening drugs. There was another way to get them, and it was even easier to hide. The medicine drawers in the Pyxis machine weren't always organized by drug classification. Sometimes they were organized by size or how often they were used, which meant dangerous drugs could be mixed in with more common ones. Charles realized he didn't even have to order the drugs he wanted. He could request something, something harmless like Tylenol, but grabbed Digoxin instead. The canceled Tylenol order would look even less suspicious, since it wasn't unheard of for nurses to type in the name of something commonplace when they were in a rush. Charles couldn't believe he hadn't thought of this before, but now that he did, he put it to use. On October 21, Charles poisoned another patient with digoxin. Even though the patient's blood work came back positive for that drug, there were no orders for it under Charles's name in the Pixis machine.

[Dr. Tristan Engels]

So police are closing in. And when police close in, some offenders panic and stop. Serial killers like Charles often do the opposite. By virtue of being serial offenders, they're more experienced. They have had time to refine their methods, become more calculated, deliberate and instrumental. And during their active time, their successes reinforce their behavior and desensitize them to violence. And when you really reflect on Charles, he has been caught countless times, and maybe not with enough evidence to arrest him, but with enough evidence to fire him. And despite this, he was giving glowing recommendations and he was able to continually move on and find work rather easily and quickly. And that creates a feedback loop that reinforces, emboldens, and builds arrogance and confidence. Psychologically. He became entitled and now the risk is part of the thrill and a measure of his mastery, which is why he's not pulling back or stopping, but rather continuing to refine his methods.

[Vanessa Richardson]

Charles definitely kept finding a way to stay a step ahead of the detectives. So to catch him, they devised a two part plan, which they carried out on October 30, 2003, almost four weeks into their investigation. That morning, as 43 year old Charles was driving to work, he was stopped by police and the officer said his car was being impounded over unpaid parking tickets. Charles insisted that it must be a mistake, but the officer said it wasn't and offered him a ride to the hospital while he sorted it out. Charles was right. He didn't have any unpaid tickets. In reality, detectives Braun and Baldwin had gotten a judge's approval to seize his car so they could install a hidden tracking device. A few hours later, the car cop who impounded his vehicle returned his car and apologized for the error. And then came the second part of the plan. Before the end of his shift, administrators called him into an office. When Charles sat down, they told him he was being let go. They reportedly said there were issues with his previous employment dates on his application. Charles was dumbfounded, but there was nothing he could do. Once Charles left Somerset for good, investigators tracked his car's location so they could know if he started working at another hospital. Then in late November, their investigation picked up when the results of Florian Gall's postmortem came back. The medical examiner found digoxin levels that were so high, he changed Florian's cause of death from natural to homicide. It was the first official confirmation that one of Charles's patients had been murdered. But police knew medical homicides were no traffic. Notoriously hard to prove. What they needed more than anything was a confession. They knew Charles would never give them one, at least not knowingly. By now, detectives knew how close Charles had been with his fellow nurse at Somerset Hospital, Amy Loughran. One day, Braun and Baldwin sat down with Amy and showed her Charles's pyxis records Amy was a skilled nurse and she saw the pattern in Charles his orders. Immediately, Amy was heartbroken. She could hardly believe her friend was capable of this. But the proof was right there. So she asked the detectives what they needed her to do. A few weeks later, on December 12, 2003, Amy invited Charles to meet up at a diner. Since Charles had left Somerset, they had a lot to catch up on. After some small talk, Amy mentioned the all the rumors swirling around Charles. Then she cut to the chase. She told Charles she knew he'd been killing patients. In response, all Charles said was that he wanted to, quote, go down fighting. As he said this, detectives Braun and Baldwin listened in because Amy was wired and Charles's words were enough to warrant an arrest. As soon as he left the restaurant, a patrol car car pulled up and officers arrested him. At the station, detectives interrogated Charles for hours. Charles sat with his knees pulled up to his chest like a child. At times, he even laid on the floor in the fetal position. The only words he uttered were I can't, I can't, I can't. After nine hours of questioning, Charles was given a break and sent to his jail cell. The detective started knew he wouldn't fully confess to them, but maybe he would talk to Amy. They brought her into the station. While in the interrogation room with Charles, Amy was kind and warm. She knew he was a killer, but she still hoped her former friend would do the right thing. And her strategy worked. Charles soon began spilling everything. The detectives finally had what they they needed. By December 14, 2003, Charles admitted to 40 murders that he could remember.

[Dr. Tristan Engels]

The fetal position, the shaking saying I can't repeatedly and acute panic show an overwhelmed stress response and a regressive defense mechanism. Regression is when an individual reverts to earlier, more immature behaviors or coping mechanisms in response to stress, trauma or overwhelming situations. Childlike behaviors like thumb sucking or fetal position would be characteristic of regression. And people in that state often turn to the nearest attachment figure. And Amy, even though she in a way betrayed him and was part of his downfall, was the most available and familiar attachment figure. There are several possible reasons he admitted to his crimes, particularly to her. But when we think back, I think there was only one time that he outright denied his crimes, and that was at St. Luke's all the other times, he never really outright denied it. In the past, when confronted, he responded once with, you can't prove anything. Instead, he could have said, I didn't do it. When he was let go, he didn't Push back. He didn't fight. So now things are different. This confession could be related to guilt. It could be a bid for comfort or protection. It could be an attempt to control the narrative or a rehearsed self justification. But I think more simply, the situation overwhelmed his defenses entirely.

[Vanessa Richardson]

Well, now that the floodgates were open, people started coming forward with their suspicions about Charles. Once the story went public, police were flooded with tips from patients, families, and former co workers who had encountered Charles throughout his 16 year nursing career. The callers provided names of people they thought Charles may have killed. Investigators had a list of nearly 200 possible victims, and the only way to make sense of it was with Charles help. So they offered him a deal. If he agreed to plead guilty and help them cross reference the list with patient records and his own memories, they would take the death penalty off the table. Charles accepted the deal. And while authorities only gained enough evidence for some murders, it was better than nothing. In April of 2004, Charles pleaded guilty to killing 13 patients and attempting to kill two others. The list included John Yango, Helen Dean, Otto Schramm, Matthew Matern, and Florian Gall. And that was just the beginning. By March of 2006, Charles was convicted of 29 murders total and six attempted murder murders, earning him 18 life sentences. During his trial, Charles admitted the real number was closer to 40 victims. But with missing records and long decomposed bodies, many of the murders could never be confirmed. Some experts estimate that Charles's true victim count could be closer to 400, which would make him America's most prolific serial killer ever. Which makes it all the more haunting that Charles. Charles never offered a clear motive for his crimes. At one point, he claimed that he only killed patients who were suffering as a way to show them mercy. But considering how many patients had a good shot at recovery, few people believed him.

[Dr. Tristan Engels]

So let's talk about his motive. Offenders often offer acceptable motives to reduce shame, frame perceptions, or gain legal advantage. Sometimes they truly do believe their own rationalizations, as I think Charles likely does.

[Vanessa Richardson]

Does.

[Dr. Tristan Engels]

But it's rarely that simple clinically. What likely motivated Charles, and I know we've highlighted this, but just to recap, were grievance and a need for control. He felt wronged and deprived, blamed institutions, and used medical access to reassert power and gain control. Additionally, he displayed patterns of projection and identification with the aggressor. He displaced his suicidal rage onto patients. He became the very thing that he felt betrayed by in medical care and institutions. And he framed killing as, quote, mercy to reduce unbearable shame and with that gratification followed because he gained a sense of mastery, power, secrecy, and the reinforcing feedback of success. There were also secondary gains like attention, avoidance of exposure, and a perverse sense of heroism, which also fit the pattern. But realistically, mercy was a rationalization, one that allowed him to continue his actions. But revenge, control and predatory behavior were very likely the driving forces.

[Vanessa Richardson]

Well, even though Charles himself has never expressed a believable motive, Experts like you, Dr. Engels just now have said that he likely killed people out of a deep desire for power and control and as a way to lash out at the system. As of this recording, Charles Cullen sits in a New Jersey state prison in trouble Trenton, where he's expected to live out the rest of his life. His family no longer speaks to him. They're still haunted by everything he's done. And so are his victims loved ones. At the same time, one small measure of comfort came from Charles's crimes. In 2005, the state of New Jersey passed what's now known as the Cullen Law, which ensures medical professionals report on unsafe or unauthorized behavior. Dozens of other states passed similar laws. In addition to that, Pyxis machines now have crucial safeguards in place, like each drug being stored in its own locked compartment and regular inventory checks. These measures are designed to strengthen oversight and prevent someone like Charles from slipping through the cracks ever again. Charles Cullen cold blooded vengeance fueled his heinous crimes, but ultimately his growing confidence was his undoing. By believing he was always one step ahead, Charles paved the way for justice to finally catch up to him. Thanks so much for listening. Come back next week for a new deep dive into the mind of a killer.

[Dr. Tristan Engels]

Killer Minds is a Crime House original. Powered by Pave Studios. Here at Crime House, we want to thank each and every one of you for your support. If you like what you heard today, reach out on Instagram at Crime House. And don't forget to rate, review and follow Killer Minds wherever you go. Get your podcasts. Your feedback truly makes a difference and.

[Vanessa Richardson]

To enhance your listening experience, subscribe to Crime House plus on Apple Podcasts. You'll get every episode of Killer Minds ad free along with early access to each thrilling two part series and exciting Crime House bonus content. Killer Minds is hosted by me, Vanessa Richardson and Dr. Tristan Engels and is a Crime House original. Powered by Pave Studios. This episode was brought to life by the Killer Minds team. Max Cutler, Ron Shapiro, Alex Benedon, Lori Marinelli, Natalie Przofsky, Sarah Camp, Markie Lee, Sarah Tardif and Carrie Murphy. Thank you for listening.

[Dr. Tristan Engels]

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[Vanessa Richardson]

Cmintmobile.com Looking for your next crime house? Listen, don't miss Crimes of With Sabrina Diana Roga and Corinne Vien. Crimes of is a weekly series that explores a new theme each season from Crimes of the Paranormal, unsolved murders, mysterious disappearances, and more. Their first season is Crimes of Infamy, the true stories behind Hollywood's most iconic horror villains. And coming up next is Crazy Crimes of Paranormal real life cases where the line between the living and dead gets seriously blurry. Listen to Crimes of every Tuesday on Apple Podcasts, Spotify, Amazon Music, or wherever you listen to podcasts.