08 October 2017

Hospitals and Murder in One Step or Two

“Hospitals are a great place to kill people” said MC, during our interview, “You can kill people in one-step or two.”
I would like to reintroduce MC – Mystery Cardiologist. He is a doctor who opens up blocked heart vessels with stents, puts in new heart valves and uses defibrillators to bring people back from the brink of death. He is also a voracious reader of mystery novels. What can be more delicious than a man who saves lives and ponders how to kill people? After he read my last blog, he felt it made him sound a bit ghoulish. So I would say, unequivocally, that he is a great guy. A wonderful husband, father, puppy owner who has never murdered anyone. He is safe to have over for dinner and introduce to your children.

Although his one-step and two-step murders are worth hearing about, what is equally as interesting is the character of a hospital murderer.
“There is nothing more creepy than someone like a nurse, doctor or paramedic who kills.” said MC. “That is the person with the most access to the patient, the knowledge to kill and the person everyone trusts.”
MC is right. The best person to know what drugs could kill and at what dosages, is a person who is medically trained. Further, they would know, for example, that in death, all cells break down, release sugar, and make an insulin overdose difficult to detect. However, a sample of the vitreous humour (fluid in the eye) could be a perfect way to catch this murderer.

Setting a murder in a hospital opens up avenues of murder but also allows for the creation of a complex character. What makes someone who has devoted a great deal of time educating themselves on how to save lives, who has a career of service to patients, turn themselves into a killer?  It could be a latent aggression finally coming to the fore, or it could be a character up against hard times who changes and becomes embittered. Or it could be a character who becomes a doctor or nurse to compensate for a sense of helplessness but gradually develops a sense of arrogance and invincibility, coupled with the a distain for those who are helpless like they once were.

One-step murders in hospitals can involve numerous methods. If someone is admitted to hospital for routine surgery such as an appendectomy or even for a heart attack that they survived, then finishing them off in hospital is an interesting option.

In hospital, people have IVs that provide a portal to inject them with something deadly. An overdose, of insulin, epinephrine, or potassium are some of MC’s suggestions.

A two-step murder is another intriguing option. Perhaps a murder attempt - a car accident, or bludgeoning on the head - has failed to completely kill off the victim. Bringing them to hospital provides an opportunity to try to kill them again.

Here a principle of reversing medical treatment is key. For example, if the victim has brain swelling after a thump on the head, in hospital they will give drugs to reduce swelling. They will also raise the head, using gravity to get rid of excess fluid in the brain. A visit during which the hospital bed is positioned to lower their head will send enough fluid into their brain to kill them. It is a gruesome way to die as the brain swells and pushes into your skull and again, it takes a certain twist of character to make a person trained to save lives, now take them.

Killing via an IV line is of course an option when a murder is botched and someone wants to complete the kill. Insulin injected could bottom out their glucose and put them into a deadly coma. Adrenaline could cause a fatal heart attack. And someone who has survived a murder attempt would be frailer and more susceptible to most drugs. Air injected into an IV is a perfect way to kill someone.

Once you have decided to set up a hospital murder, either in one or two steps, there is a wealth of internet info to look at. For example, if you are set on killing someone with air injected into an IV, I would like to recommend the blog by James J Murray, Prescription for Murder, as a great starting point. Another intriguing find is a book about murder by insulin.

For me, the intriguing part of my interview with MC was the hospital setting as an opportunity for murder with a necessity of developing the kind of complex character who would murder in a hospital. I truly think this hospital killer allows a writer to develop a character that embodies the saying: ‘As we get older, we just get more so.'

All our vulnerabilities, our fears and frailties, can be hidden under work and purpose. However, in the end we all become ourselves and more so. What haunts us eventually will consume us and that, in essence, is the making of a murderer.


  1. Welcome to Sleuthsayers, and what a fine and thoughtful, if macabre, introduction!

  2. That's a bloody good article for Halloween month, Mary, playing upon our fears of homicidal nurses who bump off in the night.

    Referring back to your previous article, insulin pumps have proved to be as vulnerable to hacking as pacemakers. It could be possible to target a diabetic almost anywhere.

    Whoops, time for granny's insulin injection, her heart medication pill and that new seizure med her niece practitioner Nurse Hardgravel prescribed…

  3. Mary - stop - you're giving away all our secrets! grin. I'm a former hospital and CCAC director. Welcome to our motley and rather macabre crew here! You sure fit in.

  4. I never liked hookups to IV lines, but as long as they're at it, couldn't they dump in a load of fat reducing brew? At least I'd die thin.

  5. Welcome to SleuthSayers, and what a great post! Thank you for the link to the Murray blog. I know I'd need all the help and info I could get to devise a murder in the hospital that would be plausible.

  6. Mary -- Welcome to SleuthSayers! Great column.

  7. Terrific piece! Thank you, Mary, and welcome aboard.

    Years ago I read a fascinating book by John D. MacDonald - non-fiction - called NO DEADLY DRUG, about the Coppolino murder case (or more exactly, the two of them, a year apart). It's an examination of the American trial system, the adversarial process, with F. Lee Bailey for the defense, but it's also very much about forensic evidence, and all the varied means medical professionals have at their disposal for dirty deeds (Coppolino was an anesthesiologist).

  8. Seems the plain old pillow across the face has worked for some.

  9. Thank you so much for your comments!
    I can't figure out how to answer each one so here is my best shot.

    Leigh- we have a nurse in Ontario who just killed 8 people http://www.cbc.ca/news/canada/london/wettlaufer-court-nurse-killings-plead-guilty-1.4140973
    Interesting read. And many thanks for all your amazing help.

    Melodie- Thank you for the warm welcome! I wonder how many of us in health care think about murder...

    Eve- the internet is full of fabulous resources. If you have questions, please ask. I probably don't have answers, but i have friends who do and we have many private message boards where i can ask doctors for info. I also have some writer/doc friends who would be happy to give advice on whether the plot works medically

    John- Thank you!

    David- great reference. Thank you!


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