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

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.

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)

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)

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 |

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.

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.