Medical Murder and the origin of Sharp Scratch by Martine Bailey

Why is healthcare such a rich setting for crime fiction? Medical murders certainly feature in my own favourite crime novels, from nursing whodunnit A Shroud for a Nightingale by P D James, herself a former hospital administrator, to the psychiatric mystery of The Silent Patient written by therapist Alex Michaelides. As a young hospital Personnel Officer in the 1980s I appreciated the NHS as a place of healing but also learned about its shadow side, from cases of fraud and false documentation, to violence and sexual abuse. My training course in psychometric testing at an Oxford college couldn’t have contrasted more starkly with Salford’s abandoned docks, 1960s tower blocks, and dilapidated health centres.

Could a personality test detect a killer? That was the question a Chief Nurse asked me on my return. The subject has simmered in my mind for decades and sprang to life again as the inspiration for my new novel, Sharp Scratch. My lead character, Lorraine Quick, returns from her psychometrics course to witness her best friend dying from a routine flu jab switched with a lethal dose of anaesthetic. A hidden killer is at work in the hospital and suspicion falls on the management team. Set in 1983, the novel takes place at a critical moment for the NHS, heralding Margaret Thatcher’s introduction of a General Manager for each hospital focussing on inefficiency and cutting costs. Lorraine’s job is to test candidates for the top job and interpret the results.

Desperate to beat his bumbling boss to an arrest is Detective Sergeant Diaz, who spots the parallels between Lorraine’s testing skills and the exciting science of offender profiling he’s discovered in the FBI’s Bulletins, developments later celebrated in the Mindhunter book and TV drama.

The 1980s were an era of psychological discoveries and certainties. David Hare produced his ground-breaking Psychopathy Checklist to assess the controversial mental disorder characterized by callous self-centredness allied with a remorseless use of others. Later in my career I was to work with staff in high security hospitals that housed many ‘psychopaths’ detained by the courts. The personality disorder units housed only male patients, most of them young, bored, and menacing.

In the US, crime author Thomas Harris introduced to fiction the idea of psychopaths being studied by FBI agents, beginning the Hannibal Lector series with Red Dragon. I believe that we all have a fascination with confronting the demonic ‘shadow’ inside us, from shape-shifting gods to the haunting bogeyman, and today’s sadistic serial killer.

To write Sharp Scratch I revisited textbooks that brimmed with confidence about psychopaths’ skills as crafty liars who will try to guarantee their ‘success’ by presenting a false persona. However, since they are said to deny any negative traits, when taking a personality test a liar’s Motivational Distortion score (a hidden trap to detect ‘Faking Good’) should reveal a warning to the tester. That’s the theory, though I must add that outside of a novel no test can perfectly predict future performance.

Since the 1980s, the crimes of GP Harold Shipman, nurses Lucy Letby, Beverley Allitt and more, have proved that healthcare murder not only happens in fiction. Dr Herbert Kinnell writes in the British Medical Journal that medicine has arguably produced more serial killers than all other professions put together, with nursing a close second. Paradoxically, health workers are considered to be naturally benevolent, providing a highly effective mask for malevolence. Many health roles allow for time alone with vulnerable patients, access to powerful drugs and, for some, the opportunity to dispose of a victim’s body without further question. Crime writers enjoy exploring these gaps between perception and reality. Consider the golden age classic, Christianna Brand’s Green for Danger, a whodunnit set in a World War II hospital, the screen adaption of which was originally banned for fear of undermining confidence in the health system. Yet more chilling, Robin Cook’s Coma turns a hospital into a grotesque harvesting centre for stem cells and organs.

Medical murder plays on fears of our own vulnerability and the vast power gap between patients and the all-knowing specialist. Then there is the labyrinthine nature of a hospital itself, its menacing equipment and, as I remember it, the vast building’s half-life in the dead of night.

As for using psychometrics to catch potential killers, recent discussions have seen efforts to assess candidates for hospital roles against profiles of common traits found in medical serial killers, but to my knowledge these precautions are still not in place.

Thankfully my own psychometrics training led to a happier outcome. Feedback confirmed that my own introverted and intuitive personality was not well-matched to work in Personnel – but primarily suited to be a writer. One result, I am happy to say, is Sharp Scratch.

Reference: Kinnell, H ‘Serial homicide by doctors: Shipman in perspective’ British Medical Journal (2000) D1594-7 

Sharp Scratch by Martine Bailey (Allison & Busby) Out

Now Five candidates. One job. A killer prepared to murder their way to the top. Salford, 1983. Lorraine Quick is a single mother, a member of a band going nowhere fast, and personnel officer at the grim Memorial Hospital. A new general manager position is being introduced, and Lorraine's recent training in the cutting-edge science of psychometric testing will be pivotal. As the profiles start to emerge, a chilling light is cast on the candidates. When a lethal dose of anaesthetic is deliberately substituted for a flu vaccine, and a second suspicious death quickly follows, it's clear a killer is at work in the hospital. Can Lorraine's personality tests lead her to the murderer?

 Martine Bailey qualified in psychometric testing, and over her NHS career assessed staff for a top security psychiatric hospital. Having written acclaimed historical crime fiction, she has now jumped to a modern setting. Sharp Scratch is the first of a new crime series available in hardback, ebook and audio and will be released in paperback by Allison & Busby on 18 July.

More information about Martine Bailey can be found on her website. She can also be found on Facebook. You can follow her on X @MartineBailey and on Instagram @martinebaileywriter