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Police interview Elizabeth Wettlaufer in this video.

Why did she do it? Why did she kill eight of her patients?

Behind Elizabeth Wettlaufer's lurid confession that she became a serial killer because she felt a "red surge" while she gave lethal injections to her patients, is the tale of a troubled nurse who couldn't handle the thankless demands of her job, looking after elderly people.

Court exhibits filed Thursday, after Ms. Wettlaufer pleaded guilty to murdering eight patients in the Woodstock, Ont., area, detail how she had been in trouble since the start of her nursing career, stealing drugs and ultimately killing people as a way to relieve her anxieties.

"By giving vulnerable people a potentially lethal dose of insulin, she felt both more powerful and a release of this pressure," says a summary in her discharge file from the Centre for Addiction and Mental Health, the Toronto facility where she revealed her homicidal past, which eventually led to her arrest.

In a four-page handwritten confession, she repeatedly described herself as being frustrated as she faced patients with dementia who were unco-operative, physically abusive or despondent about life.

"While alcohol and opioids provided her with some relief from the stress at times, she often could not find an adequate method to manage the building pressure," the CAMH summary says.

"She explains that she started to intentionally overdose patients whom she was working with in order to relieve the stress."

The summary says she was diagnosed as having a major depressive disorder, borderline personality disorder and antisocial adult behaviour, accompanied by mild alcohol- and opioid-use disorders.

"I was a binge user," she said about her addiction to the painkiller hydromorphone. The remark came as she was interviewed by police before her arrest in the fall of 2016.

She explained that she would hoard her patients' hydromorphone and give them instead a laxative pill. "They couldn't tell the difference," she told Woodstock police Detective Constable Nathan Hergott.

She told him that she initially worked in remote Geraldton, north of Thunder Bay. Without providing details, the CAMH summary notes that "she had her licence restricted for a time early in her nursing career due to overdosing on hospital medication while at work."

By 2014, after her divorce, she was hired by the Caressant Care facility in Woodstock, where she was in charge of 32 patients during her overnight shifts.

"I definitely think that stress played into it," she said during her police interview.

Describing to Det. Constable Hergott the eight murders, four attempted murders and two aggravated assaults that she committed, Ms. Wettlaufer said that "part of me started to believe that it was the devil and part of me thought it might be God."

But she also acknowledged that she struggled to cope with her tasks. "It's a hard job and then they would add different things like, `Oh, you have to do this and that, to say who's here and counting the medications at the end of the shift,'" she said. "I always was putting this pressure on myself to be a really good nurse and to do everything perfectly."

The first five patients that she murdered – James Silcox, Maurice Granat, Gladys Millard, Helen Matheson and Mary Zurawinski – either had Alzheimer's disease, dementia or were known to be difficult to the staff. In her written confession, Ms. Wettlaufer repeatedly described herself as being angry or exasperated when she gave them fatal injections.

Between the fall of 2011 and the summer of 2013, there was a 20-month gap in the killings. She said she was trying to stop her homicidal streak by immersing herself in the Bible. "I was trying very, very hard to get close to God," she told Det. Constable Hergott.

Then in July, 2013, she went back to killing, murdering Helen Young, 90, who had dementia, and Maureen Pickering, 78, who had dementia and Alzheimer's disease.

"Sometimes I had to be with her one-on-one, as well as give pills to 32 people, do paperwork and do treatments ... I was angry, frustrated and irritated," she said in her written confession about killing Ms. Pickering.

Family and friends of seniors killed by a former nurse say they were disgusted Thursday as Elizabeth Wettlaufer pleaded guilty to eight counts of first-degree murder. The victims' friends and family are calling for reform in long-term care.

The Canadian Press