This is part one of a series of Substacks covering analysis and events around two women who this year were convicted within days of each other, of murdering children and babies. This Substack also comes with a reader warning as some of the details are harrowing.
On 16 August 2023, Laura Dickason, a forty two year old South African national and doctor, was convicted in New Zealand of murdering her three daughters. These murders had been committed within weeks of her and her family migrating to New Zealand in 2021. Dickason killed her six year old and twin two year olds in their home in Timaru. Dickason was found guilty by a jury of eight women and four men, in the High Court in Christchurch of murdering her babies. She pleaded not guilty to the murders and is yet to be sentenced, but is expected to receive a whole life sentence.
A few days after the Dickason conviction, seas and continents away in England, a jury of seven women and four men in the Manchester Crown Court, returned a guilty verdict regarding another woman in the health profession, named Lucy Letby. Thirty three year old nurse Letby had been on trial for twenty two charges comprising seven counts of murder, and a further fifteen of attempted murder of newborn babies. Her crimes took place between June 2015 and June 2016 in the Countess of Chester Hospital (the “Countess”) in Chester. Like Dickason, Letby also pleaded not guilty. Letby was given fourteen whole life orders for the charges for which she was found guilty of.
Laura and Lucy, two women with medical qualifications, shocked those around them by their heinous actions.
Albeit tenuous speculations, I see some other intriguing similarities between the two. Chester and Christchurch are both Cathedral cities for example. Both Christchurch and Manchester, where the trials were held, have both been the target of devastating terrorist attacks. In both cases, the victims involved twins. Both murderers were supported by their parents throughout their arrests, charging and conviction. They both had blonde hair and fair skin and had a temperament that would not be associated with the violence of their crimes. It is also notable that despite Dickason being the mother of the babies she killed, like Letby, she was not genetically related to her victims. Dickason’s three children were conceived using an egg donor.
The biggest difference between them however is that Dickason had a strong history of mental health issues, and relied on this as a defence, and unlike Letby, was post natal. The sad irony here is that whilst it was plausible that Dickason’s acts were consumed and affected by the postnatal drop of hormones and general horror a woman’s body and mind endures in pregnancy and delivery, and caring for newborns, Letby meanwhile preyed on women just like Dickason.
Letby took advantage of vulnerable women like Dickason whose babies were born preterm, had caesarean sections and/or had been the product of fertility medicine, and whose babies were twins necessitating neonatal observation.
Contrastingly for me, the most obvious glaring link between these two cases is that these murders could have been stopped had every mother involved, including Dickason, been given adequate support.
A CAREER TO KILL FOR
Taking Letby first, a young, slim, smiley faced neonatal nurse. An only child, and first woman to go to university in her family, she had wanted to be a nurse all her life according to reports. She was born in Hereford, not too far from the part of Wales I am from. Hereford is an idyllic town, the type that would be good for a day out.
Letby succeeded in her goal of wanting to be a nurse, and qualified as a registered nurse in 2012. She was based at the Countess from this time and undertook training at Liverpool Women’s Hospital. From 2015 however, over the period of a year, strange happenings began to occur in the neonatal ward of the Countess’s neonatal ward. Babies began to collapse, “desaturate,” shriek, stop breathing and in some cases were bleeding from the mouth. From the news reports I gleaned the gist that there had been “spikes” in the number of deaths in the neonatal ward. Two who died were from triplets. We now know that they were murdered. There were news reports of senior medical staff getting suspicious and one doctor, Dr Ravi Jayaram, who believes he saw her standing at a baby’s cot, as she watched over the baby with its breathing tube disconnected. Like many involved in the case, as an onlooker my mind was stretched at the thought that a woman and nurse could do so much harm and that doctors' concerns would be ignored. It is the stuff of the movies. Or is it?
THE TRIAL OF LUCY LETBY BY THE MAIL
A few days after the verdict, A UK friend who was also from Manchester, suggested that I listen to the Mail podcast, entitled the Trial of Lucy Letby (the “podcast’). She said that it detailed the harrowing circumstances, events and evidence in which each and every baby in the trial was attacked and murdered. I thought that each and every baby deserves their experience to be shared in this way. The babies were named from Baby A through to Q.
As such the podcast, The Trial of Lucy Letby, by The Mail, has hugely shaped my view on Lucy Letby’s actions. The podcast, which was released weekly to reflect the weekly evidence presented to the jury (and so first of its kind) in her trial, had been downloaded now over three million times in June 2023, and also had a strong following in Australia. The presenters are journalists Liz Hull and Caroline Cheetham.
The podcast reveals strong themes of behaviours that Letby would exhibit around the deaths and attacks, before and after. For example, text evidence confirms her detailing that she disliked being in the unit where the healthier babies were, and would often have been designated in that unit, only to then, moments later after sending those texts, get involved in the care of a baby in the higher risk unit, only for such baby to be harmed. She would later text her colleagues in what appears to be fishing for sympathy after the babies being in crisis, when it was she who killed and attempted to murder them.
The podcast also explains the modes and themes that emerged from the way babies were killed by her. It explains the medical processes of how the babies died. I do not believe that accessing this information is voyeuristic, or satisfying needs to go deeper on death. I am not going to go into the details of the deaths however, and instead recommend this podcast because it provides those details well, and gives factual, medical and circumstantial evidence for anyone who wants to understand how the jury came to their verdict.
As a lawyer, crux points of the case for me however, were that Letby essentially had no defence. She conceded for example that two of the babies were poisoned by insulin, just not by her. She claimed that the deaths were due to failings due to the ward management, e.g. cleanliness, but conceded that these did not cause the deaths. She also claimed that evidence of things doctors, nurses and parents gave, were lies. The list of professionals who were lying was hard to believe.
THE NURSE SERIAL KILLER
Letby is not the first nurse to have committed murder in a clinical setting. In the UK she is preceded by Nurse Beverely Allitt. In America there is Kristen Gilbert and Donald Harvey.
Yet despite the writing on nurse serial killers, the media, medical profession and the general public, cannot reach consensus as to why Letby killed and attacked these children.
For example, Dr Sohom Das has offered that it was not mental illness, and that instead there was some “power play” or revelling in the pain of the parents' aspects to her actions. Meanwhile I particularly found Dr David Holmes' analysis interesting. As a criminal psychologist, he states in this video that Letby had strong psychopath traits and more interestingly, adds that people are born psychopaths. In this video he explains that psychopaths have a brain configuration that lacks empathy and a need to control things. He further adds that when born as a psychopath, parents can do little to rinse out these tendencies in their children, apart from perhaps steer them to professions like surgery where they can be disinterested from outcomes.
Yet the UK’s favourite psychiatrist Dr Raj Persaud, believes that she is not a “traditional psychopath.” In this video he believes further that Letby was not a sadist (which he believes that Judge of the case suggested in his summary). He backs this up by saying that it wasn't obvious what pleasure she was getting from the killing of babies, but perhaps a pleasure from another link to the deaths. As regards psychopathy, whilst he believes Letby exhibits some traits associated with psychopathy, such as a lack of emotion and empathy, he stresses that psychopaths know exactly what they are doing and why. Persaud says that psychopaths know and see the upside of what they are doing. Yet to him, the evidence on Letby suggests that not even she knew why she was doing what she did. In the video he looks at a range of reasons for why nurses kill, suggesting the God complex theory and the nurse who is addicted to seeing “crash” situations.
Meanwhile, I found this article also very important as it unpicks the psychology of how we treat women in these situations. Here, Dr Jessica Taylor suggests we must accept that women can inflict the same harm as men. I also welcomed Dr Taylor’s analysis that we are conditioned to see women as kind and gentle, that often in these situations we search for a reason that involves a man making a woman do such a heinous thing.
For example Rosemary West, Myra Hindley and Ghislaine Maxwell were all seen as controlled by their male accomplices. In Letby’s case, one of the propositions offered by the prosecution was that Letby engineered crisis situations by attacking babies to get the attention of a Dr A. It is suggested that Letby was infatuated and was having a “relationship” with Dr A, a married registrar that cannot be named for legal reasons. The podcast details the messages they exchanged both on and off shift and how after attacking babies, Letby would request Dr A come and attend to the babies. I agree that there is a possibility that she could have killed for Dr A’s attention, but I do not see these murders as her being a victim to being a woman wanting a man’s attention.
THE WORKPLACE
Tragically, Letby was also enabled to kill. It is now hard to hide from the realisation that had hospital management heeded staff concerns about both the spike in deaths, and unusual circumstances in June 2015, that more babies would not have gone on to be attacked and killed. So how did this happen and what can we take from an organisational management perspective to address how she slipped through the net? Indeed, can any analysis of these babies' deaths ignore the pathology of the workplace, and the personalities involved when and where the babies were attacked?
Inappropriate Relationships
For example, my own experience has shown that where there is workplace discrimination and bullying of employees, there is almost always the presence of an inappropriate personal and/or sexual relationship between someone of a senior level and junior level. This inappropriate relationship often leads to people “teaming” off with one group knowing and supporting the relationship, and another group, or lone person seeing the relationship for what it is, namely an affair that results in compromising service delivery.
The podcast details exactly how inappropriate the relationship between Dr A and Letby was. Side effects of this relationship involved staff texting Letby about his supposed “crush” on her and more shockingly, both Dr A and Letby texting each other whilst they were both at work when they were supposed to be looking after Britain’s most vulnerable babies.
For me, these crimes and the way they were handled make a strong case for severely reprimanding medical professionals for using their phones for personal reasons with staff. Even further, there is potentially a case from these deaths that there should be guidelines on reporting personal relationships in hospitals to avoid them affecting clinical standards and care.
U ok hun?
The neonatal ward at the Countess was a women-heavy workplace. It was surprising as to how much these nurses had crossed lines of professionalism with each other. The court was offered text evidence of the nurses discussing the babies after work. Many of these texts had “XXX” meaning kisses, after the words. They called each other “hun.” Were they supporting each other? It could be argued that these women were massaging each other’s egos on text, talking about how hard their jobs were. Had they crossed lines of professionalism? What was the need for the kisses?
Many texts discussing the shifts involved these women ending with a “X” to each other. This was so disappointing to read as the over-familiarisation between these nurses seems to have put them in a position where lines were blurred, to the point that sight was blurred that there was a killer amongst them.
And, outside of the medical sector, another significant factor which leads to workplace problems is precisely when women cross emotional lines with each other, to the point that one woman finds it very difficult to raise a valid work issue with another due to a relationship that once may have involved “xxx” on text, and texting outside of work hours.
Intuition
The evidence as presented in the podcast showed quite clearly that Letby was a step ahead of her colleagues’ intuition. She killed when she knew that a nurse was about to step out, or a parent about to go home to get a child from school, or to catch some sleep. When one mother followed her intuition to go and see her baby, Letby dampened it by convincing her to go back to bed. The timeline suggests that one baby’s mother had arrived moments after her baby had some object forced down its throat. The mother saw the blood on the baby's face but trusted Letby that it was ok. Letby denied this conversation took place, but the mother had called her husband moments later who corroborated that the mum did go and see her baby.
In the workplace, bullies and aggressors work by operating on their intuition to the detriment of everyone else. Their affair, their favouritism, their intuitions are king whilst everyone else, who may have intuition that something is going pear shaped is seen as “over sensitive.” I have welcomed the term gas-lighting for her actions.
Many attempts were made by parents working on their instincts that there was something not right in the ward where their babies were dying and being harmed. Whether it was the odd comments Letby made straight after their baby had died or before a baby died, their instinct that their child did not make a noise that was correct or that she was standing over a cot acting strange. This case is a classic example of a world we live in where intuition was fobbed off by a killer and management.
Deny, Defend and Labelling in Management Styles
And so the other tragedy around this case is that so many key staff raised concerns and yet this was ignored by NHS managers. I agree that perhaps Letby was too clever to be caught and further down I will address how Letby duped people, yet it cannot go unnoticed that this ward had a catastrophic failure in management. And for this I think we should question the extent to which we allow organisational management terms to dictate work behaviour and outcomes.
For example, we know that Dr Ravi Jayaram and Dr Stephen Brearey noticed early on that not only were the deaths unusual, but that they were also “associated” with the presence of Letby. Yet both these doctors were ignored. In fact they were ignored and taken so not seriously that one NHS manager suggested that they should be reported to the General Medical Council for their sustained focus on Letby. The doctors were also asked to write an apology to Letby. Letby even had the gall to raise a grievance at work.
Indeed in organisational management and mindset terms, I can see why these two doctors were fobbed off. It's clear that Jayaram and Brearey would be seen as “catastrophists” in suggesting the babies were being killed. It would also seem that Letby, nice and calm and always ready to help, would be seen as “amiable.” Meanwhile the NHS managers and Nurse shift managers who supported Letby, and in some cases were happy to have her on the ward, would be seen as “drivers” getting a hold of situations. But isn’t this labelling precisely the problem? That organisationally we rely so much on labels and behaviours, that we actually become blind to actual behaviours and cues?
This follows neatly into the discussion of racism facilitating the deaths of these babies. Articles suggest a body of thought, which includes the The Nursing Times, that had Letby not been white, she would have been stopped earlier. The assertion that whiteness has got something to do with crimes has angered many seeing this as race baiting. Firstly I would say that Dr Jayaram’s brown skin colour would have absolutely had some, even if minor, part in the reasons why he was not believed by the management about his concerns on Letby. I can also see how Letby being white would have made her less visible as a danger to the babies. Even the police describe her as “beige” which I think infers her blending in. Being white helps you blend in. But what I think is most pivotal in her not being caught, is that irrespective of Letby’s colour, she presented as “angelic.”
To explain further, in the workplace we have visions of what goodies and baddies look like. Baddies are often skinny women who look haggard, almost witch-like. People talk about women at work with “resting bitch face”. This refers to a woman who permanently looks stroppy. Meanwhile people with big eyes, or bright features may be seen as animated and kind, or even gossipy. Fat people can be seen as warm and cuddly, or lazy. Fat women get called “battle axes.” Men who dress in sharp suits can be seen as aggressive and arrogant. Taller doctors who dress in a “fuddy duddy” way can be seen as “handsome.” Women with untamed hair are also treated as if they are untame.
We may think some professionals present in clinical settings in a way with which we associate with ethnicity and presentation. I was once annoyed that a young doctor who was tending poorly to one of my babies in the early hours of the morning in a UK hospital, when she had an infection, seemed more interested in having straight hair and posh nails than understanding my baby being ill. This was laying bare my incorrect bias that the doctor should not look perfect.
Vitally, Letby also had another ace up her sleeve of disguise - her voice. Letby was a woman who spoke calmly and slowly. Many leaders will know that this is usually seen as a good sign. We label calm voices with composure. Of course now that we know she was a murderous monster, we can use this calm voice to add to her so-called psychopathic traits. But crucially this can only be surmised after all the evidence that showed that she was the only person linked to babies who began bleeding for no reason, who were poisoned with insulin, who were attacked so badly that their liver looked akin to what a liver looks like in a car crash. Before this was known, absolutely everything in her demeanour and presence worked in her favour as not being the baby killer. But voice is everything and a marker of work competency.
Hospitals and environments where lives are there to be saved bring out intense human emotions. In an environment like this, I can see exactly how Lucy Letby, the slim golden haired fair young lady, would have been the last person people could accuse of being a serial killer. And, given what the media and story books in all cultures teach us about what a good woman versus a bad woman looks like, I think it would take someone with a lot of courage to back themselves that she was the killer, that it turned out that she was.
Yet there was one moment when Letby showed some behaviour, that I believe suggest that she was not beige nor amiable in the workplace at all. And this was closer to the end of her killing spree where shortly after she had attacked a baby, a specialist team from Liverpool’s Women’s Hospital appeared on the unit to manage the baby. This instance was mentioned in the podcast. One of her colleagues noted that suddenly, by the presence of this team, Letby became visibly agitated on their arrival. She was questioning who they were as if they should not have been there. For me, it is clear that Letby did say a myriad of odd things to parents that made them think she was dodgy, but these instances were also disguised with kindness that these parents were gas lit in to not calling out. But the way she behaved when this specialist team arrived was the one slip in her perfect facade. It tells me that she had built territorial control over that unit and perfect conditions for killing. Had she not been the killer, why would she care who those people were? And so this makes me think that another way this tragedy could have been avoided, and many other work issues can be avoided is by such settings being frequently visited by external teams giving feedback, so that we can fall out of the hypnotic states we fall into in all aspects of our life.
THE HOME
Yet one aspect of this case that I felt the podcast and press reports have yet to analyse, and an aspect of Letby for which we have not seen much counter analysis, is her upbringing. Reporters and commentators, police and more seem to have not really offered much on her family.
Above we learned that Dr David Holmes believes that Letby would have been a born psychopath, and that a parent of a psychopath would do well to steer their child in to a job that would suit that trait. Holmes suggests a paediatric surgeon where one is detached from an outcome. Meanwhile, most reports describe Letby as being adored by her parents. We are told she had the perfect upbringing abundant with love. At this point I will add the Fred West was also the apple of his mother’s eye.
I agree with some commentators that it is really odd that some press outlets have issued a photo of Letby when she was a young girl. She looks angelic. But I also questioned what relevance the photo has in this case? Yes it perhaps adds to the intrigue. But all in all it strikes me that when we attempt to look into her upbringing that we are training ourselves, much like those hospital staff were, to think that there was nothing odd there.
But what if there was? What if we set aside our assumptions of what a bad murderer looks and is raised like?
I would be interested to know exactly what type of a relationship she had with her parents. Why did her Dad assemble her bed when she was arrested and place the toys on it? Why did she go on holiday with her parents multiple times a year? What was she like at school? I also noted this habit she had of writing cards to her victims’ parents and of receiving cards from her mum on her cat’s birthdays. It is a noble thing to write a card, but was Letby doing it as a practise she learned to soothe herself?
Also why was this woman in her 20s having a bedroom that looked like that of a younger child? Has any of her upbringing got to do with her pursuing a married man? Although I have not read that anything sexual took place between her and Dr A, why was she having a relationship with him that involved messages deep into the night. I have also read that Letby had discussed that she herself had a traumatic birth. Was this true and if so, was it connected in some way? The podcast also reveals texts to a colleague about her feeling that her parents could not live without her. Was she therefore suffocated by them? The mind boggles as to whether she killed babies because she herself wished she had died at birth? Did her parents put her on a pedestal as a result of her difficult birth? This of course is all rampant speculation.
Indeed if psychologists, psychiatrists and the like are not coming forward with theories then maybe there really is nothing to add from her childhood to her crimes to think they were linked. But, I still can’t quite seem to shake off one feeling I have about Letby, and that is accountability.
What we do know about Letby is that she shows no remorse throughout the process. Police confirmed that she showed no anxiety that there was a killer that needed catching. We also know that she insisted on being sat in the courtroom first, before everyone else shuffled in for the trial. This tells me that she lacks accountability in her actions and yet knows how to ask to have her needs met, even when in trouble. That is a red flag. I don't think the average person mistaken for murder would dare make a request that they be sat first. If she was my child, I would be telling her not to rock the boat.
Perhaps Letby was never enabled to grow up and take responsibility? I have seen this in adults who despite being fit and healthy, seem childlike and do not seem able to take responsibility for their actions. These people usually also have overly connected relationships with their parents, see themselves as a child and as such, are still bound by their parents for correction and affirmation. That the mother wrote her cards from her cats to Letby was also bizarre. It seems the stunted parent child relationship was two ways. And from what I have seen from people who are stunted in this way by their relationship with their parents to the point that it cripples them, is that crucially society does not play a part in their life as a corrective order. Is this what drove Letby to have shown these babies such little mercy and own up? And to this point, I do urge you to listen to the podcast as it really does detail the extent to which babies cried for help and were ignored. And the timelines prove that some babies were repeatedly assaulted. Does she not see the magnitude of her crimes as she has never been taught what is right and what is wrong? Does her life centre on just what her parents think of her?
Similarly I cannot possibly believe that Letby had a full history of kindness. I remember a woman who was also a former nurse telling me about her own daughter. I was talking about how exhausting it was having three girls and dealing with three sets of girl cliques. But she said, “Our girls are kind little girls.” Now I nearly choked on olive when she said this as I factored in her nursing profession when she said this, and was thinking about how earlier that day, my daughter had told me that this woman’s daughter had given her mother’s number to a child for a play date, and at the end of the day went up to that child and asked for the note with her mother’s number on it back. And no this was not a one off. I had thought this woman’s comment was amusing, but also thought that she was short changing her daughter because no one’s child is perfectly kind.
Yet whatever the speculation, sadly why Letby did what she did, we will only ever learn if she confesses.
AND FINALLY
The friend who sent me the podcast had accompanied it with her view. She wrote that “challenging figures in authority is a must when your instinct is telling you and also to know your rights.” As I had not listened to the podcast at the time, I did not quite comprehend the application of these words.
But having poured through the episodes and a lot of other information on the nature and processes during which these babies were attacked, a few days after, I would surmise this terrible situation in exactly the same way.
The tragedy of this case for me is that it confirms that motherhood is the most neglected aspect of society there is in this world, and it is hard to believe these mothers and their babies were so flagrantly neglected, in the one setting they were supposed to be safe.
But, without vilifying nurses, I will add that I have had my own experience of seeing a registered nurse complicit in horrendously separating a mother and newborn in Canada. There is discourse on cases in New Zealand and the UK of mother and babies being treated poorly in hospitals and cases about baby swaps, and baby abduction, may not be frequent, but they do exist. It's important to note that there is another case in the UK press of a young nurse currently being accused of harming babies in Birmingham. The state of the NHS can therefore not be ignored, but perhaps for another part to this series.
One of the biggest eye openers of motherhood for me has been seeing and experiencing how hard it is to speak up when you become a parent, and how exhausting it is. The reality is that most parents do not ask for help, when they really need it. From what I see, many parents do not always speak up, but that is their choice. What is abhorrent in this situation is that these people were like rabbits in the headlamps from delivering very unwell and very small babies, they were at their most vulnerable and then being taken advantage of by a serial killer.
And in that situation it behoves other people to speak up for them and their babies.
Lucy Letby’s case should be a stark reminder of the sheer courage these parents showed in fighting for their babies' lives which has contributed to justice being served. Other people also showed up for these parents, like the doctors involved who fought the management tirelessly to get Letby off the ward. In some cases, mums were so strong that they demanded their babies be taken off the ward. In others, grandparents kept a watch over the babies. Some couples raised legal actions and inquiries into what happened to their babies, not even knowing there was a murderer on the ward. And now more parents are coming forward after recognising the face of Letby and recalling an incident with their own baby. This is not over.
If you are wondering, as soon as Letby was removed from the ward, babies stopped dying in strange circumstances, and screaming in agony and similar. Two things I will never forget from researching a range of perspectives is that firstly, neonatal babies don’t make noise (like the babies in the trial did on attack), and secondarily, babies with underlying serious life threatening issues don’t usually come back on resuscitation (as many did because they had been attacked). Letby killed and killed but the science helped her get convicted.
And to clarify, whilst some babies survived and “came back” after Letby’s assaults, many have life changing conditions as a result of oxygen deprivation to the brain, physical assault and poisoning, to name just a few of her killing tactics.
The Countess neonatal ward has been the cause of enduring trauma to the babies and families concerned. I am sure that there is more we can unpick, but at the end of the day, that ward, its people and the relationships, should be no different to every scenario we step into involving babies, children and their mothers. I welcome all calls for inquiries and accountability of the management and staff who did not act sooner.
And clinical setting or not, it behoves us to stand up for every baby and child no matter where and when. If there is anything we should take away from Lucy Letby, it is exactly that.
In part 2 we will take a look at convicted murderer and mother, Laura Dickason.
I hope this Substack informs your outlook.