The following is an excerpt from When She Was Bad: How and Why Women Get Away with Murder by Patricia Pearson.
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.
One such killer is typical, in a number of ways, of all the others: a middle-aged nurse who was known to her coworkers in small-town Ontario as Bethe Wettlaufer. When the scholars were publishing their 2015 review of her fellow predators, Wettlaufer was winding up a decade-long killing spree that, to this day, would have gone completely undetected if she hadn’t decided to walk into a Toronto psychiatrist’s office and confess.
Eight people had died at her hands, she confided. She’d injected them with lethal doses of insulin between 2007 and 2016. There were, she added, six more victims who survived, in three different long-term care homes and one private residence. These were men and women with long, vibrant lives and families who loved them and were shocked by their sudden passing but accepted the institutional write-offs, the lack of autopsies, and the shrugging condolences: Old people. They die.
On October 16, 2016, Wettlaufer was arrested and charged with eight counts of first-degree murder. Police would later add four counts of attempted murder and two counts of aggravated assault. She pleaded guilty to all charges and was sentenced to life in prison, where, like many female serial killers, she has said virtually nothing that explains what she did.
We know some scant facts. Elizabeth Wettlaufer grew up in a farming community in southern Ontario, where everyone knew her as Beth Parker, the daughter of middle-class Christian fundamentalists. According to John Lancaster’s in-depth reporting on Wettlaufer for the CBC, her father was active in the Baptist church and was, according to childhood neighbour Glen Hart, “very controlling.” Hart recalled Beth’s early fight for autonomy at school. When, at the age of seven, the small, bespectacled child was being teased by classmates who called her “little Bethie Parker,” she changed her name to Bethe with an extra e. As if the pronunciation of Beth-ee had been her own call all along.
After high school, Wettlaufer enrolled at a Bible college in London, Ontario, to get a bachelor’s degree in counselling. Her father, however, took courses alongside her and, reportedly, monitored her for lesbian tendencies. (He’d found out that she had propositioned a girl in high school and been rebuffed.) At some point, the press later reported, she agreed to try conversion therapy. Whether or not this happened and turned her against the counselling profession, she got her degree but then studied to be a nurse instead, securing her licence in 1995. There was trouble on the job almost immediately. Wettlaufer stole tranquilizers from Geraldton District Hospital and took them on her shift. When she was caught, she repositioned her substance use as a suicide attempt. She was fired but protested. As detailed in a later public inquiry led by commissioner Eileen Gillese, she and her bosses reached a settlement that said she had resigned “due to health reasons.”
Two years later, Bethe Parker married a truck driver and fellow Baptist named Donnie Wettlaufer. For a decade, she was employed as a personal support worker by Christian Horizons, a facility for people with disabilities. In 2007, however, her husband discovered that she was having an affair with a woman and ended the marriage. She and her lover, who hasn’t spoken publicly, moved briefly into an apartment together. Wettlaufer’s mother, Hazel, later insisted the romantic pair were “roommates” and that Donnie Wettlaufer had actually left her daughter because “he didn’t want a sick wife”—which is to say, one who had claimed bouts of depression and attempts at suicide and had been diagnosed with borderline personality disorder.
In the year when her marriage dissolved, followed quickly by the ending of her love affair, Wettlaufer, now thirty, found work as a night nurse at a home for seniors in Woodstock, Ontario, called Caressant Care. It was a squat, three-storey, dorm-style building in pale-grey brick where she was given exclusive charge of thirty-two patients on one floor for the duration of her shift. She also had unsupervised access to the medicine cabinet. Within weeks, the new nurse overdosed an eighty-eight-year-old diabetic woman named Clotilde Adriano with insulin. Adriano survived because other nurses treated her low blood sugar levels when they came on shift, assuming that their resident just needed her medication adjusted.
Wettlaufer became a student of insulin overdoses. She wasn’t sure how much dosing was required to end a life. She googled it. Was there pain involved? How long did death take to come? As she made her rounds on the floor, she also experimented on Adriano’s sister-in-law, Albina DeMadeiros, an immigrant from Portugal who had farmed tobacco with her husband before she was widowed and then institutionalized with dementia. DeMadeiros bounced back from the blood sugar drops, unaware that she was being attacked, as did Adriano, whom Wettlaufer overdosed several times. Later, Wettlaufer would tell an investigating officer in her relaxed and chatty statement that anger motivated these early attempts at murder, although she also played up the idea that she was mentally ill: “The different times that I have caused people’s death or caused them discomfort through the insulin, I believe it was the influence of that voice or whatever it was, the voice in my head.”
It took Bethe Wettlaufer three months of experimentation to get the fatal dosage right. The recipient was an eighty-four-year-old stroke victim who was, she said, annoying her. On August 11, 2007, James Silcox was anxious and disoriented and calling out for his wife, Agnes. The lanky and dignified war veteran had sunken into dementia. Wettlaufer grew “angry” at the mutterings of this “senile oldster.” As she later told detectives, she “wanted him to die.” She loaded an insulin pen with twice the dosage she’d tried on the sisters-in-law and—succumbing to what she described as “the red surge” of rage or power or blood lust—plunged the pen into Silcox’s frail body. Perhaps he caught the glare in her eye and mistook it, in his cognitive disarray, for an expression he was surprised to see on the face of his wife, for his last words before passing out, according to Wettlaufer, were “I’m sorry” and “I love you.”
Just shy of Christmas Eve in 2007, a retired tinsmith named Maurice Granat fell victim to his nurse’s killing rage. He had, she later claimed, sexually harassed her, so she told him he was going to get a vitamin shot. Marching down the hallway, she fetched her insulin and returned to inject sixty units into his thin leg. Hours later, before finishing her shift, she wrote up a note on Granat: “At 05:00 resident was found diaphoretic [sweaty] and struggling to breathe. Pulse was 120, resp was labored. Family were called at this time.” Then she went home. He died at noon.
By early 2008, Wettlaufer had found another romantic prospect online, a woman who worked in a prison cafeteria out west. This one backed away after their first in-person visit, telling the CBC in an interview that Wettlaufer was off-putting when she came for the weekend. “She pouted a lot and [had] little temper tantrums, you know, like if she didn’t get something her own way, like my affection. There was a lot of childish issues with her, and I just thought, ‘You’re a grown woman. Act like it.’”
Is a serial killer childish? It’s an interesting question. They are certainly arrested in their development, with a new and lethal identity emerging that must be kept hidden, sometimes, one suspects, to their regret. For what power they have accrued! Wettlaufer responded to the woman’s rebuff by plunging a retired butcher named Michael Priddle into hypoglycemic shock at Caressant Care. She also wrote coy poems, which she posted online under pseudonyms: “Where am I left then / What would they say? / Yes, what will they say / When the real truth is known? / When it is found out, / What I do alone.”
At one point during this injuring and killing spree, she drove to her pastor’s home and confided it all to him and his wife over tea. “They prayed over me,” Wettlaufer later told police. “And they said to me how this was God’s grace. ‘But, if you ever do this again, we will have to turn you in to the police.’”
Huh? Did they not believe her? Was the nurse insufficiently threatening to take seriously? What else did they think she was on about, then? Maybe they were used to her saying outrageous things. At any rate, she ignored the feeble warning.
Before she confessed to her crimes, at least one of Wettlaufer’s colleagues referred to her as an “angel of death,” according to testimony at the inquiry. “Bethe would spend a lot of time with palliative patients, and someone overheard her telling a patient, ‘It’s okay to die,’” Karen Routledge, who was also the home’s nursing union rep, testified at the 2018 inquiry. “I didn’t think that was an appropriate thing to be telling a patient. It’s not a nurse’s place.”
Perhaps, when you have monstrosities to conceal, the lesser transgressions can go on full display. Wettlaufer certainly continued with substance abuse. One colleague found her “passed out” in the basement at Caressant Care on the night shift. She was reported for often stealing hydromorphone from patients, sometimes swapping their meds and giving them laxatives while she swallowed their painkillers. Wettlaufer also made sexual remarks to the residents, punctured a hematoma with unsterilized scissors, and once hoisted an elderly patient suffering from a broken hip despite him crying out in pain.
In disciplinary meetings about her treatment of staff and patients, her habitual lateness and no-shows, her apparent medication errors, Wettlaufer would round her shoulders in a defeated slump and rue her mistakes. “She was remorseful, tearful . . . And, for a couple of weeks, things would improve,” Routledge testified. The nurse never slurred her words or seemed impaired, it was pointed out. She wasn’t falling-down drunk. The fact that Bethe Wettlaufer was manipulative, as many psychopaths are, seems not to have dawned on anyone; they blamed themselves at the inquiry in apologetic vexation, as if they couldn’t quite grasp that she deliberately deceived and confused them, feigning a broken wing like a wren in the hedgerow trying to deflect a threat.
In August 2011, the administrative staff at Caressant Care recommended that Wettlaufer take a leave of absence. She refused and instead went on to kill three more patients in rapid succession: Gladys Millard, Helen Matheson, and Mary Zurawinski, three women who might have gone on to natural, peaceful deaths surrounded by loving family but instead were dispatched by a loose cannon whom nobody had the nerve to fire. A year later, staff at the home again voiced concerns about Wettlaufer to the administration. According to a CBC report, they said she neglected a resident’s breathing problems for three days, made another resident wait for pain meds, and “forgot” to treat someone’s finger injury because she was busy. “She’s still here. Nothing ever happens,” one nurse wrote in her letter to management.
Bosses warned Wettlaufer that they may report her to the Ontario College of Nurses, and she appears to have cooled it for a couple of years. But, in the summer of 2013, Wettlaufer suddenly decided that Caressant Care resident Helen Young, a Scotswoman with dementia whom she described later as “very difficult to deal with,” had to go. The elderly woman, who hated being institutionalized, would call out, “Help me, nurse,” and frequently complained of her misery, protesting that she’d rather die. On July 13, Wettlaufer’s “red surge came back,” and she silently told Young, “Okay, you will die.” Out came the insulin pen, and as the evening progressed, Young’s face turned red, her eyes bulged, and her limbs bent rigidly while she went into seizure. After she died, the nurse then consoled one of Young’s relatives, who wept on her shoulder. “It was the ultimate act of control and betrayal,” a journalist covering the inquiry would write. “Describing her crime to police, Wettlaufer said she felt ‘the surging’ and ‘laughter’ afterward, which was really like ‘a cackling from the pit of hell.’”
Wettlaufer was finally fired—following numerous warnings, a one-day suspension, a five-day suspension, a string of medication errors, and a final murder for the road. There were so many examples of her misconduct that, when her boss filled out a five-page termination report for the Ontario College of Nurses, she couldn’t include all of them; she ran out of room. Yet, according to the CBC, she later testified, “It didn’t cross my mind that she was harming residents.” Wettlaufer grieved the termination through her union and managed to receive a letter of reference from Caressant that called her a “good problem solver with strong communication skills.” The letter explained simply that the nurse left the home to “pursue other opportunities.”
From Caressant Care, Wettlaufer jumped to Meadow Park Long Term Care in nearby London, Ontario, where she chose her eighth murder victim, a Hungarian Canadian businessman named Arpad Horvath. He died in August 2014, after his nurse grew fed up with his dementia-related yells and fist swings. He tried to fight her off as she lunged with the needle, but she prevailed and he was taken to hospital in hypoglycemic shock. He had seizures and fell into a coma. No one tested his insulin levels, and no autopsy was performed. The inquiry revealed that Wettlaufer had phoned the hospital to check that he was dead.
Wettlaufer soon quit this new job at Meadow Park and checked into rehab for a few weeks. (On her last day on staff, a month after Horvath’s murder, she stole opioids and wound up in the hospital for the weekend being treated for an overdose.) Nevertheless, rehab failed on all counts. She resumed taking drugs, and the following summer, now working for a temp company at a long-term care home in the small town of Paris, Ontario, she tried to kill again, sending a woman named Sandra Towler into hypoglycemic shock; she was stabilized by hospital staff and survived. Then, finally, came Beverly Bertram, a sixty-eight-year-old woman being treated at home with antibiotic injections for an injury in the summer of 2016. She needed care and got poison. Luckily, Wettlaufer’s dose was insufficient and Bertram survived, none the wiser about why she’d suddenly felt nauseous and dizzy. A week later, Wettlaufer was offered a placement in an elementary school to help with diabetic children. In this context, she said later, she grew panicky over her temptation to kill. Was it because of the value she placed on the lives of children, or the value that others do? If children started to die, there’d be no shrugging coroners or resigned administrators. She’d get caught.
As a silent predator, COVID-19 has ravaged our elderly with grim speed, exposing the flimsy and even indifferent way we’ve been housing those who raised us, stuffing them into euphemistic “villas” and “manors” and “acres.” As painful as it may be to admit, these are not victims that Western society values. “If somebody who is eighty-one dies of COVID-19,” American pundit Ben Shapiro said in the early days of the crisis, “that is not the same thing as somebody who is thirty dying of COVID-19.” His view was widely shared. It should come as no surprise, then, that serial killers also flourish in homes for the aged, masking themselves as the healers we rightly revere.
“Part of me started to believe I was the devil,” Wettlaufer later told investigators. Whether this bothered her, or if the fact that nobody knew about it actually vexed her more, we don’t know, but after packing her bags and driving to Quebec, “thinking I would run away sort of thing,” she decided to take a train to Toronto’s Centre for Addiction and Mental Health (CAMH). Here, she could get help with a new bout of opiate withdrawal and, while she was at it, announce her serial murders. “Over the next twenty days, she confessed repeatedly—to almost anyone who would listen—that for much of the past decade, she had embarked on a killing spree to ease her own seething rage,” the CBC reported.
As investigators reverse-engineered the crime sequence from her confession, exhuming bodies and reviewing nursing logs, they also hauled evidence out of her apartment, including her computer, whose search history was telling. For one thing, the day before she decided to go to CAMH, she read an article in Psychology Today called “When Nurses Kill: Observant Co-Workers Can Spot the Danger Signals.”
In their review of dozens of cases of female serial homicide, psychologist Marissa Harrison and her colleagues formulated their own general profile of the predator rarely, if ever, profiled by Quantico or Scotland Yard:
She is likely White, has been married, and perhaps has had multiple marriages. She is probably in her 20s or 30s, and may be middle class, Christian, of average intelligence, and likely of average or above-average attractiveness. She is likely legally employed and may be a health-care worker or hold another stereotypically feminine job.
They went on:
She may have a history of conduct issues, sociopathological, or bizarre behavior and may have a history of mental health issues. She may appear arrogant, while she may also appear withdrawn. She may engage in atypical sexual behavior. She may have experienced a recent crisis, such as a relationship issue. Those familiar to her—even those related to her—are at risk, especially vulnerable individuals, e.g. children, ill, elderly.
“During the Inquiry,” commissioner Eileen Gillese wrote in the final report on Elizabeth Wettlaufer’s crimes, “I heard it suggested that the Offences were ‘mercy killings’ designed to end the victims’ suffering. Nothing could be further from the truth. When Wettlaufer committed the Offences, the victims were still enjoying their lives, and their loved ones were still enjoying time with them. It was not ‘mercy’ to harm or kill these people.” She is right, of course, but historically it has been very common to cast violent women either as insane or as merciful to their low-value victims. Miyuki Ishikawa, for example, is easily one of the world’s most prolific serial killers. A Japanese midwife, she is estimated to have killed as many as 500 infants in the 1940s, blaming their deaths on parents who were too poor to raise them. Their remains were found stashed here and there—in the house of a mortician, in a temple. Because her crimes coincided with mounting discontent about unwanted pregnancies, the public sympathized with her. When she was finally apprehended, a Tokyo court sentenced her to four years.
Upon passing a life sentence on Wettlaufer, Superior Court justice Bruce Thomas told her that “a civilized society protects its most vulnerable, its young, its infirm, its aged; those who can no longer care for themselves.” In a way, it is our very deep emotional investment in the idea that we are civilized that makes it so hard to accept that caregiving women can be bad and that we ourselves are throwing the victims into their path. We willingly consider every other issue that arises from the crimes of “angels of death” but the women themselves. Who are they? Without a vocabulary to describe female power and agency, both when it is good and when it is bad, one doubts that they themselves even know.
Excerpted from When She Was Bad by Patricia Pearson. Copyright © 1997, 1998, 2021 Patricia Pearson. Published by Vintage Canada/Random House Canada, a division of Penguin Random House Canada Limited. Reproduced by arrangement with the publisher. All rights reserved.