The Death Nurse [EN]

00:00:03: Welcome to Deadly Connections, the true crime podcast with Dr.

00:00:07: Timo Schühler.

00:00:12: It's just past two in the morning.

00:00:15: The intensive care unit rests on a dim light of night shift.

00:00:19: Somewhere monitor beeps and steady rhythm.

00:00:23: It smells like disinfectant That particular faintly sharp mixture you don't smell anywhere else.

00:00:31: And once have You never forget?

00:00:34: Dieter is sixty three Retired.

00:00:36: He had been looking forward to retirement, To his garden and travelling with his wife... ...to all the things he'd put off for years!

00:00:45: He's been here a few days now but is getting better Tomorrow maybe?

00:00:50: The doctor said Soon.

00:00:53: He has half asleep.

00:01:01: His footsteps Calm Familiar footsteps The footsteps of someone who belongs Here Who knows every corner in this place who comes and goes at night without alarming anyone.

00:01:20: The door opens, brief flash of light then dark again someone steps up to the bed.

00:01:31: Dieter feels something in his arm for just a moment an infusion pump maybe a small sound than nothing.

00:01:43: Then this heart starts to beat out of time.

00:01:51: In last episode we talked about man who sprinkled poison onto his co-workers' lunches, about heavy metals that accumulate silently and patiently inside the body.

00:02:02: About a long invisible stretch of time before anyone even thinks to start looking.

00:02:09: today it's different.

00:02:10: Today we're talking about man you would have trusted with your life A Man You Would Have Been Had To Trust Because He Was Sick because he was lying alone in hospital bed because he wasn't a nurse And you were the patient.

00:02:26: Niels Högel, a nurse working between nineteen ninety nine and two thousand five at two clinics in Lower Saxony Germany convicted of more than eighty-five murders suspected in up to three hundred and thirty two cases.

00:02:44: The most prolific serial killer in post war German history around him new, and stayed silent.

00:02:59: Well comes you deadly connections.

00:03:01: Before we get into the case a brief personal note.

00:03:05: My mother died in her hospital after long history of medical errors.

00:03:09: Treatments that went wrong.

00:03:10: moments with a system could have intervened And it didn't.

00:03:15: I don't know With certainty what happened at the very end?

00:03:20: Probably never will.

00:03:22: This case hits differently than the last one.

00:03:25: Not because the victims are less real, they aren't and I'll be naming some of them today But because this wasn't an outsider who found a way in... ...this was someone in white uniform with a badge With trust.

00:03:40: That's deadly connections.

00:03:41: Let's get into it.

00:03:43: The Case.

00:03:45: Neil Turgel grows up in Wilhelmshaven A port city in northern Germany.

00:03:49: He is an average student.

00:03:51: Plays soccer No obvious red flags.

00:03:54: His mother is a nurse, his grandmother is the nurse.

00:03:58: The profession isn't the family.

00:03:59: In nineteen ninety-seven he completes his nursing training.

00:04:03: Two years later He starts working at the Klinikum Oldenburg On the cardiac surgery intensive care unit.

00:04:11: And this where's story I'm telling you today begins!

00:04:15: I want to stop for moment on that image.

00:04:18: Cardiac Surgery Intensive Care.

00:04:20: This isn't just any ward.

00:04:22: These are patients recovering from open heart surgery, people at their most vulnerable who need around-the-clock monitoring whose lives literally depends on tubes and machines.

00:04:35: And right in the middle of all that kneels Högel.

00:04:40: The first few months go without incident.

00:04:43: Högel is soon as engaged capable medically competent.

00:04:48: Co-workers describe him as someone who steps up when things get critical.

00:04:53: Who's always ready?

00:04:56: And then the critical moments start pilling up, an unusual number of patients go into sudden cardiac arrest during a shift.

00:05:06: An unusual number need resuscitation and Hügel is always there.

00:05:11: First to the bedside Decisive Ready.

00:05:17: They call him the Resa Citation Rambo.

00:05:20: At first it sounds like a compliment but something isn't right and some of his colleagues can feel it.

00:05:27: In August, two thousand one the world holds a meeting.

00:05:30: The agenda...the unusual high number of resuscitations And deaths over recent months.

00:05:38: Everyone attends including Högel.

00:05:41: What happens next is one of details on this case that stays with me most.

00:05:45: Högel apparently afraid to be called Calls in sick for three weeks after the meeting.

00:05:52: During its absence The numbers drop significantly.

00:05:57: As colleagues notice, immediately the shift supervisor at that time keeps a list handwritten internal next to every name on the ward and number how many times that staff member had been nearby when something went wrong?

00:06:17: Next to most?

00:06:18: zero maybe one or two next to Niels Högel's name eighteen.

00:06:26: this list exists.

00:06:28: It is documented in black and white.

00:06:31: And what happens with it?

00:06:34: Nothing at first!

00:06:37: Then, In September of two thousand-and-two Hospital management at Altenburg loses confidence in Högel.

00:06:43: A senior physician informs him this directly.

00:06:47: But instead of contacting the police Instead of launching an investigation Instead asking anyone outside the hospital whether something might be seriously wrong Management offers Hergel three extra months' salary and a reference letter.

00:07:04: A good reference letter!

00:07:07: He had performed his duties, quote to our complete satisfaction.

00:07:13: With that letter Niels Hergel applies for the Klinikum Delmenhorst in December two thousand and two And gets the job... ...and keeps killing In Delmen Horst.

00:07:26: it starts immediately New ward new patients The same pattern cardiac arrests, resuscitations.

00:07:34: Deaths nobody can explain.

00:07:36: and Hergel always in the middle of it all on June twenty-second.

00:07:42: In two thousand five Niels Hergel is caught in the act colleagues observe from tempering with a patient's infusion pump injecting the cardiac medication Guillot mal without any medical indication.

00:07:58: Guillot Mal we look at that active ingredient closely in a moment.

00:08:04: That day, in Turgel's Active Killing Spree comes to an end.

00:08:09: but the story doesn't end here not even close.

00:08:15: what follows is years long agonizingly slow journey through justice system one that shows institutional failure didn´t stop at hospital doors.

00:08:28: In two thousand and six The Oldenburg Regional Court convicts hergel of attempted manslaughter.

00:08:35: Five years in prison, a lifetime ban from nursing.

00:08:39: The prosecutor publicly states there is no evidence of connections to other deaths No evidence with eighteen marks next his name on the list.

00:08:52: Two thousand and eight new proceedings New verdict Seven-and-a-half years.

00:08:59: the lifetime ban stands.

00:09:03: It isn't until two thousand and fourteen that the Oldenburg Prosecutors office launched a serious investigation into the Delmenhorst cases.

00:09:13: Hürgel confesses, thirty murders at first than more.

00:09:18: Two thousand and fifteen life sentence for six murders in Delmenhurst.

00:09:26: two thousand eighteen new proceedings covering ninety seven additional cases.

00:09:32: The trial is too large for conventional courtroom.

00:09:36: It's held as convention center in Oldenburg.

00:09:38: hundred and twenty copelaintiffs, eighty members of the press.

00:09:44: On the very first day of proceedings Högel confesses again two thousand nineteen a life sentence, eighty-five murders exceptional gravity off guilt.

00:09:56: three hundred thirty-two cases investigated in total three hundred and thirty.

00:10:04: The motive, and this as we saw in episode one is a bitter constant was never fully established.

00:10:11: The prosecution points to boredom and the hunger for recognition.

00:10:16: He wanted to be the hero their rescuer though One who triggers a cardiac arrest And then brings the patient back or tries too.

00:10:25: In many cases he failed.

00:10:27: and Then there's that other trial the one against his colleagues and supervisors.

00:10:32: Four former staff members were charged with manslaughter by omission.

00:10:36: Not for killing anyone themselves, but because they could have stopped it Because they had the information... ...because they stayed silent.

00:10:45: The verdict in that case are complex and contested But the question it raises can't be dismissed.

00:10:53: At what point does silence become complicity?

00:10:57: We'll come back to that at the end of this episode.

00:11:01: Chemistry In episode one we talked about poisons that come from outside.

00:11:06: Heavy metals, someone secretly sprinkles on two food.

00:11:10: Substances the body doesn't recognize and can't make sense of.

00:11:15: Today it's different And in some ways makes more disturbing.

00:11:20: I am a lean.

00:11:21: A trade name is not an environmental toxin or industrial product Not something you order online with fake names.

00:11:30: is a medication, a legitimate approved cardiac medication used in emergency medicine.

00:11:36: It sits in hospital storage rooms it's kept within reach on intensive care units and it saves lives.

00:11:42: when used correctly Niels Högel knew exactly what he was holding.

00:11:48: Let start from the beginning.

00:11:50: Ayamaline is a plant derived alkaloid extracted form roots of Indian snake root.

00:11:56: Rauwolffia sepentina Plant derived.

00:11:59: sound sounds harmless.

00:12:01: It isn't.

00:12:03: Nature produces some of the most potent toxins in existence, we'll be seeing that again in future episodes.

00:12:09: Himalene belongs to a class of drugs called anti-arythmics.

00:12:15: Medications used treat irregular heart rhythms.

00:12:19: To understand how it works We need take big look at How The Heart Actually Beats!

00:12:25: The heart doesn´t just beat spontaneously It follows an electrical signal.

00:12:30: Every heartbeat begins with a wave of electrical excitation that travels through the cardiac muscle tissue from top down, atria to when trickles.

00:12:41: That wave is generated by sodium ions flowing into heart muscle cells.

00:12:46: fast precise rhythmic I am.

00:12:49: Aline blocks exactly those sodium channels.

00:12:52: it slows flow of sodium ions.

00:12:54: The heart becomes calmer less excitable, slower more controlled.

00:13:00: For someone experiencing dangerous arrhythmia that's the rescue!

00:13:05: The medication rains in an out-of-control heart.

00:13:08: but what happens when a healthy or already weakened heart receives that break?

00:13:13: When someone gets an?

00:13:14: I am a lean injection.

00:13:16: they don't need far too much of it.

00:13:20: then their electrical system collapses...the heart loses its rhythm begins to fibrillate ventricular Fibrillation, the uncontrolled useless twitching of the heart muscle with no pumping function.

00:13:33: Blood pressure drops within seconds to minutes.

00:13:37: The patient loses consciousness without immediate resuscitation.

00:13:42: death.

00:13:43: This is not a slow creeping poison like in episode one.

00:13:46: this Is the targeted attack on the electrical system Of an organ that doesn't forgive mistakes.

00:13:53: and now we get to the part that really gets me as someone with a biochemistry background.

00:13:58: Heuergel didn't do this blindly, he knew the mechanism...he knew dosage!

00:14:04: He knew then an overdose would trigger ventricular fibrillation.

00:14:08: and he knew something else…that what he was causing would have looked exactly like natural cardiac arrest.

00:14:17: A patient who is already ill or lying in ICU Suddenly goes into ventricular fibrillation.

00:14:25: The alarm goes off, the team rushes in and Niels Högel is first to the bedside... ...the rescue!

00:14:33: That was his motive according to the prosecution.

00:14:37: Recognition of the adrenaline rush….

00:14:39: …the feeling of being indispensable.

00:14:41: He created the chaos he then wanted to resolve.

00:14:45: Sometimes he resolved it often didn't.

00:14:48: A brief note on a second substance.

00:14:51: In some cases Sotolol was also detected.

00:14:55: Likewise an anti-irhythmic, likewise a sodium channeler antagonist similar mechanism where the hergel deliberately rotated between these substances to avoid detection or for other reasons isn't fully established from the public record but underlying logic is the same medications that interfere with the heart's electrical system.

00:15:19: here lies the critical difference.

00:15:23: We said the tools were sitting on a shelf, ICP-MS, hair analyzers bone samples.

00:15:28: Precise methods that could have been used.

00:15:31: The problem was nobody thought to look With Ayamalene... ...the problem is different more fundamental!

00:15:37: Amalene has an extremely short half life in human body.

00:15:40: It's metabolized rapidly Primally by liver To roughly ninety percent.

00:15:46: The pharmacological effect lasts only about twenty minutes.

00:15:50: And what this means forensically as devastating.

00:15:54: If a patient survives the injection by even one day, just ONE DAY, Ayamaline is no longer detectable in their body!

00:16:03: This isn't theoretical – this was the reason so many of Hergel's cases were never provable.

00:16:09: Exhumations were ordered on multiple victims and in most cases no ayamalene found because it wasn't there.

00:16:17: too much time had passed.

00:16:20: Even in cases where patient died immediately after the injection, detection is difficult.

00:16:26: Amaline and its metabolites require targeted analysis liquid chromatography coupled with mass spectrometry LC-MS a precise method.

00:16:36: but it has to be applied.

00:16:37: It has to ordered someone has to think of it And that's exactly problem.

00:16:43: When a patient in an intensive care unit dies, nobody routinely orders a full toxicological workup.

00:16:50: The death gets attributed to the underlying condition –the physician signs the Death Certificate….

00:16:57: …the body is buried... ...the window closes often within

00:17:02: hours.".

00:17:05: What would have helped?

00:17:07: This where story gets bitter in very particular way.

00:17:10: unlike with heavy metal poisoning There's no collating agent for I am a lean overdose, No specific anti-dote that neutralizes the substance.

00:17:21: Treatment is purely symptomatic.

00:17:23: Stabilize the heart, rest the rhythm, maintain circulation.

00:17:27: That means resuscitation, defibrillation, cardiovascular support medications.

00:17:34: Exactly what's available on an intensive care unit.

00:17:39: exactly What Niels Högel himself performed.

00:17:45: He held the only therapy that could have counted what he was doing.

00:17:49: He decided who received it and how earnestly.

00:17:53: Created a crisis then played to rescue.

00:17:56: That's not a medical observation, thats a psychological picture I can't just move past.

00:18:03: There is term for this type of perpetrator in international literature Hero syndrome Angel Of Death.

00:18:11: The perpetrator creates the emergency in order to be seen as the saviour.

00:18:16: This is not unique, we'll see similar patterns in future episodes but none of that changes the fundamental truth – the therapy was there…the knowledge...the equipment..it's just on the wrong hands.

00:18:34: I want you get back a number.

00:18:39: That is the number of marks next to Niels Högel's name on that handwritten list from two thousand and one.

00:18:45: Eighteen times he was in close proximity when something went wrong.

00:18:49: Eighteen resuscitations, cardiac arrests, deaths Next to every other name on the wall.

00:18:56: zero-one maybe two.

00:18:58: This list existed it said in a draw And Niels högel went onto kill for fourteen more years.

00:19:05: I'm not saying that too be traumatic.

00:19:08: I'm saying it because that number is all you need to understand the institutional failure in this case, before we even begin to break down.

00:19:17: Let's start with people who were closest.

00:19:20: Högel's colleagues.

00:19:21: Frank Lauchstermann raises concerns as early as year two thousand – with a deputy chief supervisor!

00:19:28: He says explicitly he believes Högel is deliberately harming patients….

00:19:33: That not awake an ease?

00:19:34: A clear

00:19:35: statement?!

00:19:36: What happens?

00:19:38: Nothing.

00:19:40: Other colleagues notice the pattern, like declining numbers during a sick leave The rising raid.

00:19:45: when he's back They give him a nickname Resuscitation Rambo later in Delmenhorsts.

00:19:51: second one follows Skyth Högel.

00:19:55: they have nicknames for what?

00:19:57: He is doing and there.

00:19:59: stay silent.

00:20:00: I don't want to simply condemn that because i think it's more complicated than covid is Hospital on a shift with it and within the team.

00:20:10: making is serious accusation against the colleague.

00:20:12: It's not as small thing.

00:20:13: You need evidence.

00:20:15: you risk your job?

00:20:16: Your risk, your relationships With co-workers.

00:20:19: you risk being seen as a snitch.

00:20:22: Silence has many faces.

00:20:24: Not all of them are malicious but in the end people died And the silence contributed The clinical system.

00:20:36: This is where it becomes harder to excuse.

00:20:39: In September, two thousand and two hospital management at Altenburg loses confidence in Högel.

00:20:44: that data exists.

00:20:45: the list exist.

00:20:46: The correlation between a sick leave And the declining death rate exists?

00:20:50: That decision no police No investigation.

00:20:54: Three months of extra salary into reference letter.

00:20:58: It performed his duties quote to our complete satisfaction.

00:21:03: The former CEO of the Oldenburg Hospital later acknowledged that there were people within their institution who believed hergel was harming patients, but they had not wanted to quote create unnecessary disruption.

00:21:18: Unnecessary Disruption!

00:21:20: The oldenburg chief or police later stated that the hospital had priorer rightized its reputation over investigation on patient death.

00:21:31: I'll leave it.

00:21:37: It gets worse.

00:21:39: During the later trial, it emerged that The Oldenburg Hospital had provided legally funded witness advisors to its staff and these advisors had apparently attempted influence certain employees before they gave testimony.

00:21:56: That's no longer negligence!

00:21:59: That is active obstruction of justice.

00:22:03: When Hörgli is caught in the act, investigations begin.

00:22:07: That part works but The Oldenburg Prosecutors Office publicly states there's no evidence of connections to other deaths.

00:22:14: At the same time investigators from Delmenhorst are pushing From a very start for broader inquiries.

00:22:21: one Of them I'm Anfried Boyschers later testifies.

00:22:25: My colleague and i pushed For additional estimations.

00:22:30: We could have resolved the full scope of this case back in two thousand six or two thousand seven.

00:22:37: They weren't heard.

00:22:38: Records and lists documenting deaths at Oldenburg Hospital were only handed over to investigators long after their first murder, convicted in twenty fifteen.

00:22:50: nearly ten years too late The justice system.

00:22:55: I want you go one little deeper because i don't think these cases an outlier.

00:23:01: I think it's a symptom.

00:23:03: Hospitals are hierarchical system.

00:23:06: Physicians and nursing staff work under enormous pressure, understepping rotating shifts constant over extension.

00:23:14: In those structures culture of just keeping things running tends to take hold.

00:23:19: don't make waves Don't cause disruption.

00:23:21: Whistleblower protection in Germany was and remains legally insufficient.

00:23:27: Anyone who had gone outside The institution back then would have faced serious professional consequences.

00:23:34: That's not a hypothetical risk, that's structural reality.

00:23:39: and there is the question of death certificates.

00:23:42: In Germany when patient dies in hospital full toxicological analysis isn't routinely ordered.

00:23:49: The physician assesses situation records most likely cause-of-death cases closed and the vast majority of situations.

00:23:57: that's completely appropriate.

00:23:59: But it means a perpetrator who operates within the medical system, who understands the causes of death... ...and exploits them deliberately as structural invisibility he built right

00:24:12: in.".

00:24:13: Niels Hergel didn't invent that!

00:24:15: He exploited it.

00:24:17: At the end I'm left with no satisfying answer to this question How many of the three hundred and thirty-two investigated cases were actually his victims?

00:24:28: We'll never know.

00:24:30: The window for I am a lean detection has closed, the bodies have been buried... ...the memories have faded or work actively suppressed.

00:24:40: Three hundred and Thirty two people families who will never get an answer.

00:24:45: And somewhere in that there's very personal question i can't quite let go off.

00:24:51: When someone dies in a hospital and the circumstances are never fully resolved, when do you stop asking?

00:24:58: When is what you know

00:25:00: enough?".

00:25:01: I don't think you ever stop.

00:25:06: What remains unanswered – great deal!

00:25:08: The actual victim count will NEVER be established.

00:25:11: The moral question about complicity can't be fully resolved through a

00:25:15: court-widdingt.".

00:25:17: And Niels Wörgel himself confessed.

00:25:19: he testified that offered explanations Bottom, the hunger for recognition.

00:25:23: The adrenaline of resuscitations.

00:25:26: But whether any over that fully accounts for it?

00:25:29: Whether that's the whole truth I don't think he understands it completely himself.

00:25:34: Some questions Don't have answers.

00:25:37: They only half layers.

00:25:41: Somewhere in Wilhelmshaven or Oldenburg or Delmenhorst There are families who will spend the rest of their lives not knowing for certain whether they're father than mother.

00:25:51: The grandfather really died from his underlying condition, or whether on a Monday evening during the night shift he crossed paths with man who injected cardiac medication into a pump.

00:26:06: That not knowing is its own form of damage – one that no conviction can heal.

00:26:14: Niels Hörgels serving a life sentence with exceptional gravity of guilt.

00:26:18: The Federal Court of Justice has upheld the verdict, the Oldenburg Hospital still operates.

00:26:24: Hospitals across Germany still operate!

00:26:26: The nursing profession still exists.

00:26:29: Practised by hundreds or thousands people who do exactly what this profession is meant for – saving lives.

00:26:36: That's important to say….

00:26:37: This case an extreme exception But it's also a mirror for the structures that make exceptions possible when no one is watching.

00:26:47: I've spent this episode talking about a system that states silent, and I have also spended thinking of my own story... ...about open questions i carry in will never be able to resolve….

00:27:00: …about moments where the system could have intervened!

00:27:05: I'm saying it because i believe this podcast in cases like this one only makes sense if they reach past the spectacle.

00:27:17: If they leave a question behind, for me its THIS ONE!

00:27:21: How much trust does a system deserve that has learned to look the other way?

00:27:26: Don't have an answer but I haven´t stopped asking.

00:27:30: In next week we'll leave Germany.

00:27:33: We go to London, two thousand and six to hotel room.

00:27:37: To a man who is dying slowly and knows it better than anyone.

00:27:42: To a substance so rare, targeted or unmistakable that doesn't just kill the person... It sends a message.