The son of a doctor, Paul Mandarin came with his parents Dr. Carl and Martha Mandarin to Boston in 1954. Once Paul was old enough he helped his father around the office. Once he graduated, Paul moved to Chicago to attend college and medical school. While in medical school, Paul was injured in an accident and he became addicted to prescription painkillers. Desperate for the drugs once his prescriptions ran out he began to steal them. Repeatedly his character was questioned but the sly doctor managed to avoid prosecution. Once he finished medical school he returned to Boston and took over his father's practice, his addiction worse than ever. Dr. Mandarin's medical practice flourished with a list of patients including Mrs. Elizabeth Scarlet. Dr. Mandarin diagnosed Elizabeth's dizzy spells as her being pregnant. The doctor was surprised by her reaction to the news and realized that Mrs. Scarlet was hiding something. When Elizabeth begged him to not tell her husband or Dr. Hugh Black that she was pregnant, Paul realized just what it was she wanted to keep hidden. In 1997, the doctor was taken by the sight of a beautiful young nurse who needed a job. Immediately Paul hired Nurse Ivory and began having a secret affair with her. When Nurse Ivory became aware of his addiction, she intervened with disatrous results. Mandarin re-assigned Nurse Ivory to Tudor Manor. Mandarin then became involved in a plan to swindle money from his old friend Hugh Black. The plan failed and Hugh was murdered.