REYNOLDSVILLE, W.Va. — To her neighbor in the quiet, leafy hollow where Reta Mays returned after her overnight shift at the Veterans Affairs hospital nearby, Mays seemed like the kind of person you'd want living next door. She was friendly, waved hello and let Tina Hickman walk her dogs on her farm.

Even after rumors spread that the nursing assistant injected a half dozen veterans with lethal doses of insulin, Hickman struggled to believe Mays could be responsible. One of the men was Hickman's grandfather, an 84-year-old Army veteran who served in the Korean War.

Now, a week after Hickman watched on Zoom as Mays wept in federal court, confessing to the crimes, she is angry and wonders what made her do it. "I kind of didn't believe it, because I talked to her all the time," Hickman told The Washington Post. "I would like to know why."

Mays, 46, a veteran of the Iraq War, pleaded guilty last week to seven counts of second-degree murder and one count of assault with the intent to commit an eighth murder. But if families of the victims hoped Mays's plea would bring them certainty, that remains elusive. Why Mays injected the elderly veterans with deadly doses of insulin in the span of nearly a year, leading to their deaths from severe hypoglycemia or low blood sugar, remains an unanswered question.

Before working at the VA hospital in Clarksburg, Mays held several low-paying jobs as a jail guard and caregiver, and had a troubled family life, with a husband in prison as a sex offender. But she was more savvy than she let on to hospital colleagues, appearing eager to please while constructing an elaborate scheme to kill that eluded hospital officials for almost a year.

Mays provided a potential clue at her plea hearing, telling the judge she was taking medication for post-traumatic stress disorder. Prosecutors expect her defense team to argue at sentencing that either a trauma in her background or her PTSD led her to carry out the murders.

Mays’s attorneys declined to comment. One of them, David Hoose, is a Massachusetts criminal defense lawyer who represented a nurse convicted nearly 20 years ago of injecting four men with lethal doses of epinephrine at the VA hospital in Northampton, Mass.

Of all the deaths, the killing of Hickman’s grandfather, Archie Edgell, seems particularly cruel in that Mays apparently tried to kill him twice, according to the plea agreement.

In March 2018, Edgell arrived at VA for an examination that would determine whether he should move to a nursing home for dementia, according to Dino Colombo, an attorney for the Edgell family.

Some time during her rounds on the graveyard shift, Mays injected Edgell with enough insulin to cause his glucose levels to plummet, according to Mays’s plea agreement.

Then the next night, the plea agreement said, Mays injected Edgell a second time, causing the same reaction. But this time, just days after walking into the hospital, Edgell died. An autopsy later found four injection sites on his body.

Whatever her motive, Mays watched the veterans after she gave them insulin and sat by their bedsides as their organs shut down, said an investigator who, like others interviewed for this report, spoke on the condition of anonymity because they were not authorized to speak publicly. The deaths were drawn out over a period of several hours to a few weeks.

When doctors arrived the next morning to find the patients’ blood sugar levels had plummeted, Mays would often linger in the room as they tried to counteract the drug’s effects, a health-care worker recalled, and would overhear physicians’ conversations with family members.

Hickman wonders whether her grandmother saw the signs. Frances Edgell, Archie’s wife of 62 years, hardly left his side at the hospital. She permitted authorities to exhume her husband’s body, but she died a few months later of what the family is certain was a broken heart.

Deployed to Iraq

School announcements in newspaper archives show Mays was a good student at schools in Maryland and Delaware. She attended Glenville State College in West Virginia from fall 1993 to spring 1994, majored in accounting, and did not graduate, a spokesman for the college said.

Mays joined the West Virginia Army National Guard about six months after 9/11. She deployed to Iraq in 2003, joining about 500 other West Virginians in the 1092nd Engineer Battalion, where she was a chemical equipment repairer.

Mike Greaver, a Clarksburg resident who was in the same unit, said he hardly saw Mays in Iraq, but about six months into their service, they were among a handful of West Virginians who flew back to the United States for a week of leave. Thriving in a combat unit of mostly men required a degree of toughness that Mays seemed to embrace. “She was good around people,” said Greaver, 52.

Her final duty assignment was with the Guard’s 115th Engineer Company in Clarksburg, where Mays attended unit functions with her family, including her husband, Gordon, whom Greaver remembered as the goofy but hard-working custodian there. Greaver never knew Reta Mays to skip drill. She was discharged from the Guard in October 2006 under good terms.

“I would have never dreamt she was capable of doing something like this,” Greaver said. “This is Jekyll and Hyde if I ever did see it.”

Mays worked as a correctional officer at the North Central Regional Jail from 2005 to 2012. She was named in a 2013 lawsuit in which an inmate accused her and other correctional officers of abuse. The inmate claimed that Mays helped to restrain him and kicked him before another guard “stomped” his head.

When he awoke, the lawsuit continues, Mays “bent over him, spit in his face, and said ‘[h]ow do you like that mother f------’ and ‘you ain’t that tough now are you?’ ” The defendants denied all allegations of excessive force and retaliation, and a federal judge dismissed the inmate’s lawsuit.

Before she was hired by the VA hospital in 2015, Mays worked for ResCare, a group home for adults with disabilities in Clarksburg, where she rose in three years from entry-level caregiver to residential manager, supervising 15 employees, according to a spokesperson for ResCare’s parent company in Kentucky. The company received no official complaints during her tenure, and she left in good standing, the spokesperson said.

The Louis A. Johnson VA Medical Center is one of the biggest employers in Clarksburg, a city of 15,000 about four hours west of Washington. In the early part of the 20th century, immigrants were drawn to the town and its environs for work in the coal and glass industries. Now people come for jobs at an FBI center and in hospitals. The town, like many across Appalachia, faces a cascading set of hardships related to the opioid crisis.

Greaver remembers seeing Mays working at the hospital, wearing a blue and gold vest, shuttling patients from one part of the hospital to another. “It’s an honor for a veteran to get hired there,” he said.

On the job at VA, taking patients’ vital signs and glucose levels and in other caregiving tasks, Mays was eager to please, said the health-care worker who worked with her. “She absolutely fooled me,” the employee said. “I looked at her and thought, ‘She wants to be a go-getter.’ She was that helpful and involved.”

In the hospital setting, Mays came across as unsophisticated, with an almost childlike affect, often speaking with a high-pitched voice that might have given co-workers a mistaken impression that she was naive, the health-care worker said.

Her behavior was just the opposite, said the worker and the investigator. She figured out a crucial technology weakness that helped allow her crimes go undetected for so long, a faulty software system that was erratic in downloading patients’ glucose readings into their laboratory charts for their doctors to check in the morning.

“She took advantage of the fact that the test results would not be in the system,” the health-care worker said. After Mays’s firing in 2019, the software was fixed.

After several patients died on her watch, some of Mays’s colleagues would send each other text messages about the eerie coincidence that another patient was lost while she was working, two employees said. But they didn’t put the pieces together.

Longtime church member

Outside of work, Mays was a longtime member of Monroe Chapel United Methodist, a one-room country church in a cow pasture about 20 minutes outside Clarksburg.

Pastor Nathan Weaver said Mays had family members in the congregation, but she came alone in the two years he has served there, though her attendance was irregular. In his few conversations with her, Weaver said Mays seemed friendly and devoted to her family.

Monroe Chapel is affiliated with another nearby church and members from each church know one another. Among them are Mays’s relatives and family members of her victims, another small-town reality that makes healing uniquely challenging.

“Our community is grieving deeply with those who lost their loved ones,” Weaver said. “We are navigating many emotions: anger, surprise and profound loss, to name a few.”

At an in-person worship service the Sunday after Mays’s plea, Weaver shared a brief statement with his congregation: “Our hearts are hurting from the news we received this week. Our deepest condolences and prayers go out to the families of the victims. We are here for Reta’s family, who are navigating this incredibly painful situation.”

Weaver said he has been counseling members of the Mays family on the phone.

Mays has two adult sons. Both declined to comment. A stepson could not be reached. Her father declined to comment.

Mays’s husband, Gordon, who was convicted in 2012 of accessing child pornography, is serving a year-long sentence in federal prison for failing to register as a sex offender in West Virginia.

In October 2007, the family suffered two house fires at a previous residence within a few days of each other. Gary Schlag, a retired adjuster for Nationwide Insurance who handled a claim from Mays and her husband, said the first was determined to be an electrical fire that started on the porch; the second was ruled arson.

The Mays family sued Nationwide and Schlag, alleging the company used “unscrupulous delay tactics” to avoid making payments. The fire destroyed the home. The suit settled out of court with a confidentiality agreement. Attorneys for the Mays family declined to comment.

Angry families

Mays was fired from her job at the VA hospital in 2018, several months after being removed from patient care, after the hospital discovered she had lied about her qualifications on her résumé.

The families are angry at hospital leaders for not detecting a pattern in the deaths earlier. Two nursing managers were temporarily reassigned to administrative roles and a top administrator was placed on paid leave, where she remains, and is not expected to return, two employees said.

The hospital has placed tighter controls over insulin and other high-risk drugs, secured medicine carts and supply rooms on Ward 3A that were left widely accessible and required better accounting of drugs by its pharmacy staff.

But neither hospital leaders nor VA’s central office in Washington have undertaken a broad review to determine whether failures in hospital policy, operations or staffing played a role in why the deaths were undetected for almost a year.

“They act like nothing’s happened here,” said Colombo, the Edgell family’s attorney. “They hired a serial killer who killed seven veterans.”

Wesley Walls, a hospital spokesman, said in a statement that once the hospital discovered a pattern in the deaths in 2018, it “put additional safeguards in place, which continue to include medical chart audits, checks and balances within our pharmacy quality assurance processes and quality management reviews.”

Walls added, “The notion that policies and protocols can unfailingly stop those intent on committing crimes strains credulity.”

The VA Office of the Inspector General regularly examines health-care facilities but will investigate further, said Inspector General Michael J. Missal. He said the effort has been hamstrung by hospital restrictions during the coronavirus pandemic.

Several family members of the victims said VA still owes them answers.

“My dad loved that system,” Melanie Proctor, whose father, Felix McDermott, was killed by Mays in April 2018, said in an interview. She says she wants hospital leaders to tell her why it took so long for someone to figure out why so many veterans were dying of low blood sugar.

“You feel bad going after them,” Proctor said, “but if you don’t want to tell me what you’re doing to fix this so this never happens to anyone else, you’re stuck with me going after you.”