A Monster in the Maternity Ward

Following a 10-month trial, nurse Lucy Letby (above) has been convicted of killing seven newborns and trying to murder another six in the neonatal unit of the UK’s Countess of Chester hospital between 2015 and 2016. The jury was told that Letby methodically dispatched the infants by injecting them with insulin or air or, sometimes, simply force-feeding them too much milk.

“I killed them on purpose because I’m not good enough to care for them,” she admitted in a handwritten note found by police officers who searched her home. “I am a horrible evil person. I AM EVIL I DID THIS”, she wrote on a page of scrawls (below) that also included the words “Help Me!”

Letby was arrested three times before eventually being charged and brought to trial. That the arrests date back to 2018 is no surprise; such deaths are enormously difficult to investigate retrospectively, especially when the bodies are cremated.

Little is known about the alliteratively-named Letby. She is single, 33 years old, and described by colleagues as quiet and friendly, even geeky. In 2018, she was something of a pin-up for the hospital’s PR efforts, speaking in warm tones about the care of little patients. Many of photographs, like the one atop this page, show what appear to be a pleasant, attractive, young woman. This is hardly the glaring, sullen face of a monstrous killer like, say, Myra Hindley.

But those promos may tell us something. Letby was chosen to be the hospital’s public face because of the high regard in which she was held; in short, someone who stood out for her dedication. How does this match with the terrible acts she has now been found to have done? The answer may lie in a behavioural pattern that has not yet achieved psychiatric classification but is nevertheless explanatory: the Florence Nightingale Syndrome.

Originally intended to describe nurses who fall in love with their patients (now termed a “boundary violation” in the sociological terms that have taken over medical practice), it has morphed into a pattern of excessive caring for patients regardless of personal needs. The problem is that this is driven by a reverse projection of inner emptiness or turmoil which invariably ends badly for all concerned. If this is the case with Letby, then the term badly has assumed exponential dimensions.

If you put all your emotions into caring for your patients, without any other satisfying outlet, then sooner or latter the well runs dry, to be filled with depression and anger – anger which can be easily transposed into rage, in this case a sustained, secret and murderous rage.

A pattern soon emerges: Kill the child in your care by any of the numerous means available – smothering, cutting off oxygen, changing tubes round,  injecting massive doses of insulin, potassium chloride or morphine, or ceasing essential drugs. When these actions produce a medical crisis doctors and fellow nurses converge. Here our Nightingale Nurse will be in the forefront, often involved in pointless resuscitation while receiving much praise for her involvement.

This addiction to death and prominence is a dangerous drug, the dose of which must be repeated more and more often. It is a pattern well rehearsed in serial killers. The initial fear of being caught becomes overwhelmed by the turn-on of doing the murder and subsequent resuscitation. This is akin to the buzz killers get by being in the crowd around victims’ bodies, even offering to assist the police in their inquiries. Trophy collecting is not unusual – the trinkets allow post-facto rekindling of satisfaction.

The phenomenon of carers killing their patients is hardly new, but recognition has come much more slowly. The term ‘quiet killing’ was initially adopted. After all, it occurred in settings where death was not unexpected, if not routine, signs of killing were not obvious and, most important, the difficulty, if not impossibility, of believing a doctor or nurse could kill someone for whom they are supposedly caring. With greater recognition of the widespread nature of such killings and the disparate range of professions involved (eg, morticians, respiratory technicians, etc), the new moniker is Carer Assisted Serial Killing or CASK.

By my reckoning, CASK is the fastest growing form of serial killing at a time when the rate of typical predatory serial killing is on the decrease in most countries. When men are involved, the number of killings is exponential – Donald Harvey and Charles Cullen being two examples. Far fewer doctors figure in the ranks of killers, but those that are active have the ability by virtue of position and authority to claim more victims: Dr Harold Shipman became the worst serial killer in the UK with 246 murdered patients (some say perhaps as many as 400) on his charge list and his American counterpart, Michael Swango, is credited with 60 victims. Female nurses who kill seem to be an exceptional group, shattering the traditional view of women as non-violent irenic individuals. The conviction puts Letby in the same league as nurse Beverley Allitt at Lincolnshire’s Grantham and Kesteven Hospital in 1991, when she killed four children and seriously harmed six others.

Awareness of the risk of non-medical causes for hospital deaths must improve, and a new medical generation needs to be taught that this possibility, however remote, should always be on the radar when dealing with any and every death that occurs.

Robert M Kaplan is a forensic psychiatrist, writer and historian. He has written extensively about CASK murders. His latest book is Dark Tales of Illness, Medicine and Madness: The King Who Strangled his Psychiatrist