SERIAL KILLER: The Killer Nurse Pt. 1

He was trusted to save lives — but used his nursing uniform to hide pure evil. When Charles Cullen entered the medical field, he wasn’t looking to heal patients. He was looking for revenge. Over the course of 16 years, he quietly poisoned hospital patients across New Jersey and Pennsylvania, becoming one of the most prolific serial killers in American history. In this first episode, Killer Minds hosts Vanessa Richardson and Dr. Tristin Engels trace how Cullen’s childhood trauma, obsession with control, and thirst for vengeance led him to play God — one lethal injection at a time. Killer Minds is a Crime House Original Podcast, powered by PAVE Studios. Listen wherever you get your podcasts. For ad-free listening and early access to episodes, subscribe to Crime House+ on Apple Podcasts. Don’t miss out on all things Killer Minds! Instagram: @Crimehouse https://www.instagram.com/crimehouse/ TikTok: @Crimehouse https://www.tiktok.com/@crimehouse Facebook: @crimehousestudios https://www.facebook.com/crimehousestudios X: @crimehousemedia https://x.com/crimehousemedia YouTube: @crimehousestudios https://www.youtube.com/@crimehousestudios

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:01Vanessa Richardson?

  Hi, everyone. Before today's episode, there's another show I want to tell you about. It's called What the Fact with Connor Tomlinson from Netflix's Love on the Spectrum and Carter Roy. Every week, they take three unbelievable true facts from history and tell you the full story behind them. Plus, Connor's infectious energy that'll make you realize history is the most fascinating thing on earth. Follow What the Fact wherever you listen, or subscribe on YouTube at What the Fact Pod.

• 0:36Speaker 01

  This is Crime House.

• 0:41Vanessa Richardson?

  They say revenge is a dish best served cold, meaning if you've been wronged, you shouldn't react immediately. Instead, you should patiently wait until the perfect moment to seek your vengeance. That's exactly what Charles Cullen did. After experiencing a sudden tragedy as a teenager, Charles became extremely distrustful of hospitals and healthcare workers. He tried to find ways to cope with the hardship he'd been dealt in life. But when nothing made him feel better, Charles decided to wreak havoc on the institution he felt that wronged him and give them a taste of their own medicine.

• 1:36Vanessa Richardson?

  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 Minds, a Crime House original. I'm Vanessa Richardson.

• 1:51Tristin Engels?

  And I'm Dr. Tristin Engels. Every Monday and Thursday, we uncover the darkest minds in history, analyzing what makes a killer.

• 1:59Vanessa Richardson?

  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. Please listen with care.

• 2:25Vanessa Richardson?

  Today, we begin 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 cracks in the system for years. Eventually, he'd go on to make history as one of America's most prolific serial killers.

• 2:47Tristin Engels?

  As Vanessa goes to the story, I'll be talking about things like Charles Cullen's childhood fascination with poison, criminals who use mental health struggles to manipulate people, and why someone might think that they have the right to take others' lives.

• 3:02Vanessa Richardson?

  And as always, we'll be asking the question, what makes a killer?

• 3:12Vanessa Richardson?

  Before he was known as one of America's most prolific serial killers, Charles Cullen was defined by the kind of loss you live through but never really get over. He was born on February 22, 1960, in West Orange, New Jersey, to working-class Irish Catholic parents, Edmund and Florence. Charles was the youngest of eight children, and he was a surprise baby, born after his parents thought they were done having children. As the youngest child by several years, Charles felt disconnected from his older siblings. He didn't get much attention from his parents either. Edmund worked long hours as a bus driver, and Florence was stretched thin with eight children at home.

• 3:56Vanessa Richardson?

  Things got even harder for the Cullens when Charles was just seven months old and his father suddenly died. Now Florence had to provide for everyone. She took various odd jobs to make ends meet, which meant she had even less time to spend with Charles.

• 4:12Tristin Engels?

  There are several elements of circumstantial neglect here. As the youngest with a big age gap, Charles was simply less visible as it is, and losing his father and having an overwhelmed single parent amplified that invisibility. Without reliable attention or basic caregiving, a child is at high risk for an insecure attachment style. Clinically, that undermines emotion regulation, stress tolerance and impulse control, and it increases social withdrawal or extreme attention-seeking. It also increases the likelihood of permissive parenting. If the household also has no consistent rules, structure or limits, then those risks can turn into enduring behavioral patterns. A child may adapt the mindset of, "If I don't have rules at home,

• 4:56Tristin Engels?

  then why follow societal rules?"

• 5:00Vanessa Richardson?

  Without his parents around, Charles had to learn about life from his siblings, and he picked up on some unsettling behavior. By the time Charles was in elementary school, many of his siblings were young adults left to their own devices. Some of them started using drugs or disappearing for a while before returning home unannounced. At times, it was like a rotating door of down-and-out family members. Sometimes, his sister's boyfriends moved in, too. Charles never liked these men because they were always angry and abusive. One of them was so bad, Charles's sister ran away from home to get away from him. But the boyfriend stayed, and he turned his anger on Charles. We don't know the details

• 5:44Vanessa Richardson?

  of what this person did, but Charles was a small, sensitive kid. He didn't know how to stick up for himself. Eventually, Charles couldn't take the abuse anymore. Since no one was looking out for him, he took matters into his own hands. Charles tried to poison his sister's boyfriend with lighter fluid. It doesn't seem like the man was gravely harmed, but he didn't stop tormenting Charles either. At some point, all Charles could do was try to think of a way to escape. So he mixed substances from a school chemistry set into a glass of milk and drank it, hoping it would kill him. But it only made him sick.

• 6:25Tristin Engels?

  Okay, so this is deeply troubling, given that he's only in elementary school. Let's start with the method of poisoning. We don't know how he learned about poisoning and perhaps his interest in chemistry may have sparked that, but what we do know is that children who attempt to poison often do so because of neglectful environments, mental health issues like depression, or antisocial behavior. The reason they choose poisoning is often for practical reasons. Firstly, it's accessible. They can attempt with everyday household items, items that they themselves had been cautioned about from their own caregivers or even teachers, or they have read the labels directly on those items and learned on their own. It's non-confrontational, meaning it doesn't require physical overpowering, and it's

• 7:10Tristin Engels?

  otherwise concealed, which is practical for a small child. Charles is young and cognitively immature, and black and white thinking can make lethal outcomes feel like a simple solution. But then, he tried it on himself. And this is an indication that his environment truly felt unbearable to him, and he had severely impaired coping. This combination is significant for early moral disengagement, which is a pattern that can be predictive of high psychiatric need and behavioral escalation if it remains untreated. So bluntly speaking, this is a crisis situation for danger to others and danger to self.

• 7:48Vanessa Richardson?

  Charles was so young at this time, as you mentioned. He was in elementary school. So when someone considers dying by suicide at such a young age, what kinds of other mental health risks or life challenges are they likely to encounter down the line?

• 8:02Tristin Engels?

  Early suicidal behavior raises the risk for recurrent attempts, chronic depression, and post-traumatic stress reactions. It often co-occurs with emotional regulation problems, explosive anger or shutting down, as well as substance abuse as a maladaptive coping strategy. Attachment wounds and trust deficits also make relationships difficult, increasing isolation and risk of revictimization or aggressive behavior. And over time, this pattern can produce functional impairment like unstable employment, legal trouble, and health problems. And clinically, early suicidal ideation also predicts higher lethality later if it goes untreated.

• 8:43Vanessa Richardson?

  Well, it's not clear how Charles first got the idea to poison someone else, let alone himself, but it was clear that any chance of a happy childhood was out of his reach. Throughout his teenage years, Charles suffered from deep depression, as you said, Dr. Ingles. He often skipped school because of it and stayed in bed all day. On those darker days, the only silver lining was that he got to spend a little more time with his mom. But when Charles was 17 years old, that small joy was ripped from his hands, too. On December 6, 1977, Charles stayed home from school. His mother and one of his sisters had gone out to run errands. At some point, the phone rang, and Charles

• 9:25Vanessa Richardson?

  picked up. It was a staff member from Mountainside Hospital calling to inform him that his mother and sister were in a bad accident. They said he needed to get to the hospital right away. Charles rushed over. When he got to Mountainside, he learned that his sister had survived, but his mother did not. Charles was devastated. He asked if he could see her body so that he could say goodbye, and that's when hospital staff informed Charles that they had already sent Florence away to be cremated. Charles's grief quickly turned into outrage. He couldn't believe that the hospital would make such an important decision without talking to him first. He felt like they had robbed him of the chance to have closure. Charles

• 10:10Vanessa Richardson?

  had a hard time coping with his mother's death, as well as the rage he still felt toward the hospital. He didn't think he would ever overcome these awful feelings. Shortly after his mother died, Charles tried to take his own life again. This time, the attempt landed him in a psychiatric ward. The entire time he was there, he refused to talk to doctors or receive any counseling. Eventually, Charles was sent home to deal with his grief on his own.

• 10:40Tristin Engels?

  Charles displaced anger toward the hospital makes sense when we zoom out and consider the bigger picture. His father passed unexpectedly as an infant, and although he was too young to remember that, a loss like that can still be developmentally difficult because it affects attachment, trust, and a sense of security. He was too young, so as he grew older, he had to trust secondhand information about his father, which likely came from existing caregivers, ones that he also didn't trust, like his older siblings, for example. These developmental deficits are showing already at this stage, since he seems largely withdrawn from others and, as far as we know, doesn't have a strong social support system. His mistrust in others only deepened as a result of the experiences he had in his home,

• 11:25Tristin Engels?

  particularly with his sister's abusive boyfriend and the lack of intervention. He's incredibly depressed and spends most of his time at home, and his only protective factor, the "silver lining" that you mentioned, was the additional time he had with his mother. And now she's passed unexpectedly, and he cannot even verify that himself for closure. Charles needed concrete proof to grieve because he didn't trust people to be truthful. Psychologically, it's likely that his refusal to participate in treatment following his second attempt is an extension of that mistrust. He lost trust in adult institutions, medical and psychiatric, and their systems after this experience.

• 12:07Vanessa Richardson?

  Even though Charles refused psychiatric care, he did make an epiphany on his own. Due to his Irish Catholic upbringing, he believed suicide was a mortal sin that would cause him to spend eternity in purgatory. So he realized the reason his attempts never worked was because he didn't actually want to die. Now that Charles decided he wanted to live, he had to figure out how to spend the rest of his life. One thing he knew was that he wanted to get out of his childhood home as soon as possible, and he wanted to get as far away as possible. So Charles dropped out of school, earned his GED, and joined the Navy. He was hoping for a fresh start, but the reality was much different.

• 12:50Vanessa Richardson?

  Charles began working on submarines, and it was grueling work. Not only that, but he had a hard time making friends. His fellow sailors teased him for being pale and weak. The longer the bullying went on, the more Charles started to feel trapped. He didn't think he could spend another minute crammed inside a steel tube with people he despised. The only problem was, he had signed a six-year contract. As a way to get through the long days, Charles started drinking heavily. And if he couldn't find liquor, he settled for anything he could get his hands on, like mouthwash and even cleaning solution.

• 13:29Tristin Engels?

  Drinking mouthwash or cleaning solution when alcohol is unavailable, even in environments like this where access to alcohol may be limited, is a clinical red flag for possible dependency.

• 13:40Vanessa Richardson?

  At some point, it occurred to Charles that abusing alcohol could get him kicked out of the Navy, which he wanted, so he started drinking even more. When that didn't work, he tried something more drastic. On January 13, 1984, 24-year-old Charles drank some cleaning solution, then told a medic what he'd done. He framed it as a suicide attempt, but in reality, Charles felt certain he wasn't going to die. He had only drunk enough to make himself sick. It was an extremely risky thing to do, and Charles lucked out. He was removed from the submarine. However, he wasn't released from his contract. He was sent to a Navy psych ward.

• 14:25Vanessa Richardson?

  Just like before, Charles refused treatment. He wanted to get out of the military as soon as possible. He remained in the psych ward for a short while, but his idea didn't work quite as planned, because eventually, the doctors there deemed him fit to serve. Charles was enraged. He couldn't believe that doctors would send him right back into duty. He had poisoned himself for no reason. In his mind, they clearly didn't have his best interests at heart. The doctors may have made this decision because Charles's contract was ending soon anyway. In March of 1984, three months after he first went to the psych ward, Charles left and never looked back. He had to figure out his next step in life,

• 15:10Vanessa Richardson?

  and while military service hadn't taught Charles much, there was one skill he felt confident in: playing with poison.

• 15:19Vanessa Richardson?

  However, he couldn't shake his anger at the doctors for dismissing his mental health issues. This resentment festered on top of the disdain he already felt towards healthcare workers. Soon, these feelings helped Charles realize what he wanted to do next. He was going to poison the entire medical field from the inside.

• 15:48Speaker 03

  The police closed my sister's case in 2019. Last month, her killer commented on my post. On Reddit, true crime doesn't come from journalists. It comes from the victims, the witnesses, and sometimes the suspects themselves. People post the things they'd never say out loud, anonymous, unfiltered, and completely real. And every Tuesday, on Crimes of Reddit, we read them out loud. I'm Sabrina Deanna-Roga from Two Girls, One Ghost. And I'm Alexis Linkletter from The First Degree. Each week, one of us brings the most unhinged true crime stories the internet has to offer. And the other goes in completely blind. No prep, no spoilers, reacting in real time, same as you. And then we swap.

• 16:31Speaker 03

  And we pull every thread until the whole twisted picture comes into view. It's dark, it's messy, and the scariest part is that these are real stories posted by real people. New episodes drop every Tuesday. Listen to and follow Crimes of Reddit, available now wherever you get your podcasts.

• 16:50Vanessa Richardson?

  In the spring of 1984, 24-year-old Charles Cullen left the Navy and returned home to New Jersey. Once there, he began working toward a new career. Charles hated hospitals and medical workers, which was why he decided to wreak havoc on the hospital system from within. In May of that year, Charles enrolled in the nursing program at Mountainside Hospital, the very same hospital where his mother had died seven years earlier.

• 17:19Tristin Engels?

  Charles becoming vengeful toward hospital workers and then choosing to study where his mother died is clearly no coincidence. It's the source of where his displaced anger and projection began and clinically a continuation of that. By choosing that location, he is gaining psychological control over the people he blamed, as well as proximity to the loss he had, and that proximity also created opportunity. He gained procedural knowledge and access to medications, as well as access to vulnerable people. And clinically, this pattern reads as unresolved grief, plus chronic rage and justified retaliation, at least in his mind.

• 17:55Vanessa Richardson?

  What does it say about Charles that he would play such a long game for revenge? That's a long time to wait.

• 18:01Tristin Engels?

  Well, if you think about it, this is a continuation of his first attempt at murder when he was a child. His first attempt at murder and even his first attempted suicide included using chemicals that were available, accessible, and silent. That is what he is priming to do now, only it's escalated because he is more sophisticated and deliberate. He's seeking to exploit clinical knowledge and have clinical access to more effective materials. This is methodical rehearsal that is motivated now by anger and revenge. And this pattern also indicates he has a high level of manipulation. He's refining his tactics and has to simulate normalcy and to blend in while simultaneously hiding homicidal intent.

• 18:43Tristin Engels?

  Clinically, these are features you see with pronounced callousness, instrumental aggression, and skilled deception. He's also grooming an entire system, not just individual people or victims, and that's highly manipulative.

• 18:57Vanessa Richardson?

  Well, Charles had a plan. He knew that in order to convince people he was serious about nursing, he would have to study hard, and it worked. By 1987, 27-year-old Charles was excelling in the program and was even elected president of his nursing school class. Charles didn't just convince his colleagues that he was a good person. His false persona also helped out his dating life. The 27-year-old was working part-time at a fast-food restaurant to pay for his tuition. There, he met a young woman named Adrian Baum. Adrian worked at the restaurant too, and they quickly hit it off, mostly because Charles was a full-on love bomber.

• 19:39Vanessa Richardson?

  He showered Adrian with flowers, candy, and other gifts. Charles also confessed to Adrian about his past struggles with depression and alcoholism. However, he assured her that that was all behind him. Adrian believed Charles was a changed man with a bright future, and just six months after they began dating, they got engaged. Shortly after that, they were married, and they bought a home in Phillipsburg, New Jersey. Once they were settled in, Charles accepted a nursing position at the nearby St. Barnabas Medical Center. Now, his real plan could begin. Charles was assigned to night shifts on the burn unit.

• 20:21Vanessa Richardson?

  He tended to extreme burn injuries, which were often so bad, patients screamed in excruciating pain. Adult patients usually had an easier time coping because they could take morphine, but children weren't allowed to have anything stronger than Tylenol, and in Charles's eyes, it was cruel for the hospital to allow them to suffer.

• 20:43Vanessa Richardson?

  The children's pain reminded him of his own childhood trauma, and just like when he was a kid, trying to find ways to put a stop to his torment, Charles wanted to do the same for them. He thought about all the drugs he had access to that could make them feel better, and at some point, he stopped caring about the rules and decided to take control. Back then, hospitals didn't regulate medication the way they do now. It was standard for nurses to get whatever they needed from a supply closet. All Charles had to do to get his hands on strong painkillers was walk in and take them. No one even tracked inventory, which meant no one noticed when drugs went missing. Charles began stealing morphine from the

• 21:28Vanessa Richardson?

  supply closet and administering it to children. It didn't matter that it was against protocol. Charles truly thought he knew better than those above him.

• 21:37Tristin Engels?

  Well, Vanessa, you're definitely on to something there because when Charles was a child, he was in real psychological pain, maybe not physical pain, but psychological pain, and no one came to rescue him. He never got reliable care or comfort, so to him, he learned to expect that help wouldn't come. And then he tried to take his own life himself by ingesting chemicals. Now decades later, he sees vulnerable children in a hospital and seemingly is reading them through that same lens. It's as if he's projecting his own pain onto these children. In his mind, they're like him. They're suffering, helpless, deserving of, quote, relief, the way he once sought it. That lets him frame killing as mercy. He's showing up for them the way he felt no one showed up for him.

• 22:22Tristin Engels?

  And what he did when he was a child is he resorted to attempting suicide to end his pain. So clinically, what we're seeing here is projection plus identification with the aggressor. He's displacing self-directed rage outward, and he's using this distorted compassion narrative to justify instrumental killing. It's not mercy. It's a way to regain agency and control, but masking revenge as care.

• 22:50Vanessa Richardson?

  I feel like Charles has some authority issues. And is it common for people like this to see their defiance as maybe compassion or noble somehow, even when it's clearly not?

• 23:02Tristin Engels?

  Yes, it's actually very common. People who resent authority often recast their defiance as compassion in order to preserve a decent self-image and avoid responsibility. They often rationalize and morally disengage, meaning they reframe their harmful acts as justified, or they downplay the victim's suffering, or claim some kind of higher purpose. And framing behavior this way protects their identity, and it reduces guilt or accountability, and also preserves image and ego.

• 23:33Vanessa Richardson?

  Charles was playing God. Fortunately, it doesn't seem like he ever gave children enough morphine to cause any serious medical issues, but that only bolstered his own ego when it came to portioning out drugs. Charles's concerning behavior didn't stop there. It carried into fatherhood when he and Adrian's first daughter Shawna was born in 1988. At first, Charles embraced being a dad, but soon, he got tired of all the responsibility. One day, Adrian came home to find Shawna asleep in her crib while Charles was out for a walk. When Adrian confronted him, Charles said it was fine because he knew Shawna wouldn't wake up.

• 24:15Vanessa Richardson?

  Adrian suspected that he had used cough medicine to put her to sleep, but he wouldn't admit to it. Adrian could tell something was changing in Charles, for the worse. She just couldn't figure out exactly what was going on. To make matters worse, she was the only one with concerns, because at work, Charles feigned a positive attitude. He was extremely knowledgeable and always lent his coworkers a helping hand. He seemed like a model employee and a dedicated nurse. But in reality, Charles was looking for an opportunity to take his clandestine methods to the next level. He'd become extremely resentful towards St. Barnabas Hospital.

• 24:57Vanessa Richardson?

  He believed they weren't doing enough to help patients who were in pain. Charles thought they should be punished for this, and the best way to do that was to show them just how incompetent they were by wreaking havoc on patients. In June of 1988, a man named John Yango was admitted to St. Barnabas. John was 72 years old and suffering from Stevens-Johnson Syndrome, a rare allergic reaction that causes excruciating pain and left him badly disfigured. The condition could be fatal, but not always. Many patients recovered with time and care. Shortly after John arrived, his vitals started to improve.

• 25:39Vanessa Richardson?

  The doctors and other nurses felt optimistic about his recovery, but Charles thought they were too confident. He'd been watching John suffer under their care, and he wanted the rest of the staff to see what he did, that they weren't as good at their jobs as they thought they were. So on the night of June 11th, Charles stole lidocaine from the supply closet and injected a lethal dose into John's IV line. Shortly after, John died.

• 26:08Tristin Engels?

  Charles's rationalization here follows a predictable clinical logic. He framed the staff's hope as incompetence and his own actions as corrective. He saw this as an attempt to expose a perceived failure from the very institution he mistrusted. That lets him shift blame outward. But also, in this particular instance, there are two other plausible explanations that come to mind. Charles has been suffering from severe depression and hopelessness since he was young. Severe depression narrows cognition and biases someone toward hopeless meanings. If he's chronically miserable and never feeling improvement, but then sees a patient improving, it can create cognitive dissonance. And for someone like Charles, killing a recovering patient can be a way to resolve that.

• 26:54Tristin Engels?

  It allows him to make others share his misery or to deny them the hope he can't have, at least in his mind. However, if he is intent on proving other staff wrong with regard to their medical judgment or even their hope, then his need for control may be the primary driving force here. This would give him a sense of control over decisions, control over life and death, control over suffering or hope, control over institutional narrative, relational dynamics, and control over his own emotional state. But of course, both can be true, and it's rarely ever just one factor.

• 27:31Vanessa Richardson?

  I'm curious, what's your take on the fact that he targeted patients as a way to get revenge on the hospital?

• 27:37Tristin Engels?

  Patients to Charles are symbolic of staff competence. So harming them punishes the institution without him having to confront the staff directly, which makes sense for Charles, given his history and his pattern of behavior. But ultimately, what this does is it wrecks hospital functioning. It destroys patient trust and family confidence. It weakens staff morale and it creates fear and suspicion, which is exactly what he wants and exactly how he feels about institutions. So in a sense, this is a projection of his own beliefs, his own grief, onto the institution. It's his way of saying, "They took my closure, so I'll take theirs." But motive is rarely singular.

• 28:19Tristin Engels?

  So with that in mind, I think there are quite a few things that are driving Charles.

• 28:24Vanessa Richardson?

  Charles was clearly misguided, but despite how shocking his behavior was, he didn't get caught. To the other nurses, it seemed like John had simply taken a sudden turn for the worse. After all, he was an elderly patient in a critical care unit. After John's death, Charles continued working at St. Barnabas. Over the next couple of years, he maintained his spotless reputation. No one knew he was hiding a deadly secret. But at home, things continued to unravel. Charles had started drinking heavily again. He hid bottles of alcohol in the basement where Adrian couldn't find them. And things only got worse in 1991,

• 29:06Vanessa Richardson?

  when Adrian gave birth to their second daughter, Saskia. Charles was under more pressure at home than ever. Soon, Charles began channeling his emotions into his work. Now that he knew he could literally get away with murder, he started tampering with more IVs. And while we don't know for sure whether any other patients at St. Barnabas died as a result, hospital staff finally started to suspect he was up to no good. On February 11th, 1991, one of Charles's coworkers, a nurse named Pam Allen, was prepping a patient's IV bag when she noticed it was leaking. When Pam looked closer, she realized the bag was overfilled.

• 29:50Vanessa Richardson?

  This was highly unusual, so Pam alerted the hospital's risk manager and sent the bag for testing. When the results came back, they showed something alarming. The bag was only supposed to contain saline and heparin, a standard mix for IVs, but it also contained insulin. For people with diabetes, insulin is a lifesaving drug. It lowers blood sugar when the body can't do it on its own, but for someone who doesn't need insulin, it can cause their blood sugar to drop dangerously low. Insulin poisoning can cause confusion, seizures, and even death. Pam had stumbled upon a clue for Charles Cullen's scheme.

• 30:32Vanessa Richardson?

  He was going into supply closets, stealing insulin, and injecting it into IV bags. We don't know how many times he did this, but by February of 1991, he was on a rampage, and even with Pam's discovery, he wasn't caught. Sure, it raised eyebrows, but the hospital still never imagined one of their own staff members had spiked the bag on purpose. Instead, they chalked it up to a mishap, until the issue became impossible to ignore. On February 14th, a patient named Anna Byers was placed on an IV drip after undergoing cardiac surgery. Within 30 minutes, Anna became violently ill.

• 31:15Vanessa Richardson?

  Doctors sent a sample of Anna's blood to the lab to try and figure out what was wrong, and the results showed alarmingly high levels of insulin. Staff in the cardiac unit didn't seem to be aware of the suspicious IV bag that Pam Allen found days earlier, so throughout the night, Anna continued to crash. The medical staff stabilized her each time, but they couldn't figure out what was wrong. Finally, someone unplugged her IV, and Anna remained stable for a while.

• 31:46Vanessa Richardson?

  However, at some point, she crashed again. This time, it was nearly fatal. Not only that, but responding staff noticed that Anna's IV had been mysteriously plugged in again.

• 31:58Tristin Engels?

  Charles's predatory behavior is actually textbook, only it's being done in a professional setting. He selected vulnerable targets, in this case, patients. He used his clinical knowledge as his method and exploited routine workflows to move unseen. Expanding to other units is typical and also tactical. He's testing one word, learning detection risks, and then replicating. Offenders in the community will also test their limits. They also refine their tactics, and they escalate in similar ways. It also does sound like he was more likely than not actively monitoring Anna by how you describe this. And this was partly so that he could learn the routine of staff, but also partly so he could ensure he was successful.

• 32:43Tristin Engels?

  And it also makes me wonder if he was getting some kind of psychological gratification from this as well. Watching a patient gives him immediate feedback and a sense of mastery. It's also a reinforcing feedback loop, because every successful outcome, like the patient deteriorates, staff scramble, he stays hidden and secret, it strengthens the behavior.

• 33:03Vanessa Richardson?

  Charles seems to attack patients when he's feeling more stressed in his personal life. What does that say about him?

• 33:09Tristin Engels?

  Stress is a common trigger for many people. Under severe stress, the prefrontal cortex, the part that plans, weighs consequences, and inhibits drives, becomes less effective. Most people become more irritable, impulsive, or dysregulated in everyday ways, like some people might shout, some people might drink more, or stress eat, or snap at loved ones, or make rash decisions. A serial offender, however, has the same stress physiology but a different baseline. They have rage, they have empathy deficits, antisocial patterns, violent fantasies, and practiced methods. Killing can, paradoxically, relieve stress for some offenders, because it temporarily

• 33:50Tristin Engels?

  solves the exact internal problems that drove them, which are typically loss of control, unbearable shame, or intolerable rage.

• 33:58Vanessa Richardson?

  Charles was becoming more confident in his ability to poison people, especially as he watched other nurses and doctors lose their confidence. Soon, Anna's nurses learned that another patient just down the hall was going through the same thing as her. Fortunately, both Anna and the other patient survived, but cardiac staff were unnerved. These clearly weren't random incidents. Neither patient had a history of diabetes or related issues. There was no reason for them to experience blood sugar crashes. Suspicions only grew over the next few months, when these kinds of crashes began happening repeatedly, not just in the cardiac unit, but in all of the critical care units.

• 34:40Vanessa Richardson?

  Multiple patients suffered from inexplicable, near-fatal blood sugar crashes, and each time, their lab results showed high insulin. The lab also discovered another crucial finding: each patient had a form of insulin in their blood that wasn't made naturally in the body. In other words, it had been introduced from the outside. Once they learned this, hospital administrators finally connected the dots between all the crashes and the tampered IV bag that Pam Allen had found months earlier. Now, they realized someone in the hospital might be doing this to patients on purpose. As more patients went through this, hospital staff sent their IV bags for testing,

• 35:25Vanessa Richardson?

  and the results confirmed the hospital's suspicions: someone was adding insulin. So in the summer of 1991, hospital administrators at St. Barnabas launched an internal investigation. But when they zeroed in on their main suspect, he found a way to slip through the cracks. Soon, Charles Cullen would go on to commit murders in other hospitals, and no one could stop him.

• 36:00Vanessa Richardson?

  Happy Halloween, Crime House listeners. I'm Vanessa Richardson. Did you know horror films like Abigail and Sinister were based on true stories? Join me every Sunday this month on Crime House 24/7 for Crime House of Horrors, where I dive into four stories behind some of our favorite scary movies. From Abigail, The Autopsy of Jane Doe, Sinister, and The Taking of Deborah Logan, you'll find one thing in common: the truth is scarier than fiction. Listen every Sunday on Crime House 24/7, or join Crime House Plus for all four right now, ad-free. Subscribe on Apple Podcasts, Spotify, or at crimehouseplus.com.

• 36:48Vanessa Richardson?

  In the summer of 1991, St. Barnabas Hospital launched an internal investigation into a series of insulin poisonings across their critical care units. Hospital administrators interviewed nurses to try and figure out who would do something so dangerous and cruel. And when 31-year-old Charles Cullen sat down for questioning, his behavior immediately raised red flags. All of the other nurses had seemed scared and confused during their interviews, but Charles, who was a well-regarded nurse in the burn unit, was agitated and impatient. The head of hospital security seemed to have a gut feeling about Charles, and at some point, he asked him point-blank if he was the one poisoning people.

• 37:32Vanessa Richardson?

  In response, Charles said, quote, "You can't prove anything." After that, he got up and left the room. Now administrators felt certain he was behind things. But at the same time, Charles was right. They didn't have any proof that he was at fault. Even when they went to the local police with their suspicions, there was nothing authorities could do without hard evidence. So hospital administrators set out to find some. They installed hidden cameras in every supply closet, hoping to catch Charles stealing medication and tampering with IV bags. But by this point, he knew they were on to him, so he hit pause on his poisoning schemes.

• 38:15Vanessa Richardson?

  At the same time, Charles thought if they really wanted to catch him, they could lift his fingerprints off the IV bags they had tested. But they didn't do that, which only reinforced Charles's lifelong belief that hospitals didn't really care about saving patients' lives. Since they couldn't catch him in the act, the hospital decided to stop putting Charles on the schedule. Technically, it wasn't a firing, more like a gentle push out the door. Other than that, Charles didn't face any consequences.

• 38:47Tristin Engels?

  So this likely emboldened him even more, even if he was being silently pushed out. Feeling successful and harming others reinforces the behavior for Charles, and it inadvertently confirms to him that his methods are working, and he is in control. Those feelings can reduce inhibition and make escalation more likely. It makes him feel more capable, competent, and entitled. And this can also result in more refined methods. But now, he's also identifying with the aggressor, which I mentioned previously. That's a defense mechanism where a person adopts the behaviors, attitudes, or characteristics of an abuser or a powerful, threatening figure to cope with trauma, fear, or helplessness.

• 39:30Tristin Engels?

  In this case, it's medical workers or the system. He despised medical workers and caregivers in general, which, again, goes back to his childhood with his siblings and his home life. He felt caregivers and medical workers were incompetent or untrustworthy, and the irony is, he's become the very thing he despised. He is now the incompetent and untrustworthy medical provider that families should fear.

• 39:55Vanessa Richardson?

  Charles felt no shame about being quietly let go. At the same time, he couldn't outsmart everyone. To explain the situation to his wife, Adrienne, Charles claimed the hospital used him as a fall guy. But when he told her what happened with the IV bags, the story made Adrienne think of her old suspicions that Charles had drugged their infant daughter with cough syrup. However, Adrienne didn't want to be paranoid, so she kept her concerns to herself. A few months after Charles was let go, in January of 1992, he landed a new job at nearby Warren Hospital. It seems like some of his old coworkers from St. Barnabas felt he was wrongfully punished

• 40:37Vanessa Richardson?

  because they provided glowing recommendations, which Charles quickly lived up to. At Warren, he impressed people with his vast knowledge of different medications and made friends easily. It was like he got a high out of being popular at work. Meanwhile, his home life dragged him down. Charles continued sneaking out to the basement to drink, and eventually Adrian caught on. Between her suspicions and his substance abuse, she finally had enough. Adrian told Charles she wanted a divorce. Charles seemed to accept the news at first, especially since Adrian told him he could keep living in their house while he looked for a new place, which proved to be a mistake.

• 41:21Vanessa Richardson?

  One night, Adrian called the police on Charles and said he had drunkenly attacked her. Charles denied it, and since Adrian couldn't provide hard evidence, the officers didn't arrest Charles, but it does seem like they convinced him to stay somewhere else for the night. Because a little while later, when Charles was alone, he turned to his old, dire coping mechanisms. He mixed pills and alcohol, then drove himself to the emergency room at Warren Hospital, where he was currently employed, and said he tried to take his own life. But like before, Charles knew he wasn't going to die.

• 41:58Tristin Engels?

  In my experience working in forensic settings like corrections, whenever someone makes a suicide attempt or gesture that is timed when they know someone will intervene, or they use a non-lethal method, or they take themselves directly to get medical care, it's generally a sign of manipulation for secondary gain. In correctional settings, they have something to gain by being placed in a crisis bed and taken off of the yard, and generally it's safety-related, or a transfer to another institution. In the community, it can all... Also be manipulative, but it can also be a cry for help or ambivalence between wanting to die and wanting to be rescued.

• 42:41Tristin Engels?

  In Charles' case, I think it is more likely than not a mixture of these, and this is largely because he took himself to the hospital that quietly removed him and suspected him of criminal acts. He was taken off the schedule, and although he felt they couldn't prove he did anything wrong, being removed from the hospital meant removing his control. He wasn't able to continue monitoring them, and therefore he had no idea what evidence they might have gathered in his absence through witnesses or other means, so he was likely ruminating on this. Taking himself there specifically and having them rescue him in his "crisis" is his way of testing their competence, gauging their level of suspicion, and preserving plausible deniability in whatever way he could.

• 43:25Tristin Engels?

  He might have felt this would allow him to retain some influence over whatever came next, perhaps hoping this vulnerability he's showing will invoke some kind of sympathy, and that will prevent consequences, and perhaps in some distorted way, maybe even hoped it would allow him to return to work. It truly reads like his way of trying to regain control, which at the core was manipulative in nature. But regardless, it needs to be taken seriously. There have been multiple occasions when I did work in corrections where an act of manipulative self-harm went too far, and as a result, the individual did almost die unintentionally. So any self-harm is always treated with the seriousness it deserves during the acute

• 44:09Tristin Engels?

  event and following it.

• 44:12Vanessa Richardson?

  We don't know how exactly Charles' coworkers reacted, or if they even knew what happened, since he didn't work in the emergency department. However, when Adrienne heard what he did, she didn't feel sympathy. All she saw was an erratic and dangerous man. She filed for a restraining order. After that, Charles moved into a basement apartment a few miles from the home he once shared with Adrienne and their daughters. A few months later, in April of 1993, Charles set his sights on someone new. Her name was Michelle. She was also a nurse at Warren Hospital, and she happened to be going through a divorce, too. Charles became quickly enamored with Michelle. He felt they had a lot in common.

• 44:54Vanessa Richardson?

  He started bringing her sweets and other gifts at work and calling her at home at all hours of the night. Sometimes she picked up and had polite conversations with him, but mostly she ignored his calls. Charles couldn't seem to realize that Michelle wasn't interested in him at all. He thought they had a budding relationship. So, one night when she didn't answer the phone, Charles thought something was wrong. Maybe Michelle was sick. He wanted to check on her, so he drove to her house in the middle of the night. He knocked on her door, but she didn't answer. This only made Charles more concerned. Rather than call for help, Charles threw a brick through a window and broke into Michelle's house.

• 45:36Vanessa Richardson?

  He crept upstairs and found her asleep in bed. Charles stood over Michelle for a while, watching her sleep. Eventually, he left. In the morning, Michelle found the shattered window and all of Charles's missed calls. She immediately knew what he'd done. She called him back and told him someone broke into her house the night before. Charles freely admitted that it was him.

• 46:04Tristin Engels?

  Charles clearly became fixated on Michelle, and that escalated to entitlement and voyeuristic control. This sequence of obsession, surveillance, and forced covert entry are strong predictors of future physical violence. Now, we haven't covered any similar behavior like this, but I wouldn't be surprised if intimate partner violence was happening all throughout his marriage to Adrienne. He did, at the very least, start that relationship with her with love bombing, which can be an early indication of coercive behavior. Rejection from his employer, his wife Adrienne, and now Michelle, in addition to likely ruminating over the loss of control he was feeling with all of these things. Including loss of access to victims, all likely amplified a need to regain

• 46:49Tristin Engels?

  control and power, which then really showed up in this behavior with Michelle.

• 46:54Vanessa Richardson?

  I'm kind of surprised he would actually admit to breaking in. Why do you think he did that with her?

• 46:59Tristin Engels?

  I think this strengthens the argument that he was seeking control again. Breaking into her home got her attention. She called him and told him about what happened. And in his mind, he likely felt that he regained power. And in order to keep it, he confessed. Because by confessing, she now knew what he was capable of. It was his version of signaling dominance, and it was his attempt at coercive control. It's likely he felt this would coerce her into staying with him, but more importantly, intimidate her into being readily available and obedient going forward.

• 47:32Vanessa Richardson?

  Well, you're right. It seems like Charles found a way to control Michelle. He thought he did. Instead, when he told her what he'd done, she hung up the phone and called the police immediately. They issued a warrant for his arrest. And when Charles caught wind of it, he decided to turn himself in. However, before heading to the station, Charles washed down some pills with alcohol. Once authorities realized what he'd done, he was sent to a facility known as the New Jersey State Lunatic Asylum. While he was there, he learned that he was being charged for harassing and stalking Michelle. He was given a light fine and probation, but no jail time. Then Charles got some more good news. Warren Hospital wasn't going to punish

• 48:16Vanessa Richardson?

  him. He was welcome to return to work. Charles, once again, felt like he'd gotten away with his misdeeds with no more than a slap on the wrist. He was eager to go back to work and see Michelle. But when he did, it was clear she had no sympathy for his mental health concerns. She wanted nothing to do with him. For the next few weeks, he kept his head down and left her alone. But anger and resentment were stewing inside Charles. He was going to show everyone what he was capable of through a healthy dose of revenge.

• 49:09Vanessa Richardson?

  Thanks so much for listening. Come back next time for the conclusion of our story on serial killer Charles Cullen.

• 49:16Tristin 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 @CrimeHouse. And don't forget to rate, review, and follow Killer Minds wherever you get your podcasts. Your feedback truly makes a difference.

• 49:34Vanessa Richardson?

  And 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.

• 49:51Vanessa Richardson?

  Killer Minds is hosted by me, Vanessa Richardson, and Dr. Tristin 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 Pritzowski, Sarah Camp, Marky Lee, Sarah Tardif, and Carrie Murphy. Thank you for listening.

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