Paul Cramer grew up with his father, never knowing his mentally unstable mother, Melinda Cramer, or her family. At some point, he disowned his father and took his mother's name. After serving a stint in the military and in the Middle East, Paul moved to San Diego where he had a wild romance with Arabella "Babe" Carey. After a whirlwind romance the pair got drunk and got married. The next morning they immediately regretted their decision and agreed to have the marriage annulled.
Following his father's death in 2003, Paul sought out his mother's family in Llanview and slowly bonded with Kelly, a sister who never knew he existed. Meanwhile, another Cramer relative was in town, Paul's great-aunt Betsy Cramer. Betsy was a wealthy woman who was dying. Aunt Betsy stated that she'd give her $30 million inheritance to any Cramer woman who was unmarried and had no children. Since there were no such Cramer woman, Betsy told Paul the inheritance would be his, since he had never married. In the meanwhile, Paul discovered something unsettling--Babe had never filed their annulment papers, so they were still married! Not only did this provide trouble for Paul, (who stood to lose his inheritance) but Babe as well since she was married to the wealthy J.R. Chandler. In an effort to help Babe, and therefore himself, Paul agreed to doctor a pregnant Babe's sonogram results so that there would be no doubt who the baby's father was—J.R., as opposed to a man Babe slept with while engaged. Though he was successful, Paul lost the inheritance to the just-discovered daughter of his Aunt Dorian, Adriana. Paul believed Adriana was a fraud.
At the same time, Kelly was determined to hold on to her marriage to Lt. Governor Kevin Buchanan by becoming pregnant even at the risk of her own life. Kelly's desperation reached enormous heights when Kevin told her that he wanted a divorce. Determined to hang on to her marriage, Kelly was elated to find herself pregnant. Unfortunately, Kelly lost the child. Then as if on cue, both Bianca Montgomery and Babe gave birth at the same time. Trapped in the middle of nowhere following a storm, Babe called Paul and asked that he fly his medical helicopter to take her and Bianca to the hospital. Paul initially refused, but later agreed. When he arrived, he helped Babe deliver her baby. He then administered an unknown medicine to Babe leaving her groggy. During this time, Paul staged a chopper crash. When Babe awakened, Paul told her that her baby had died during the crash. However, when help arrived and Babe's family threatened harm to Paul if anything had happened to babe's child, Paul changed his story and said that Bianca's baby had been thrown from the chopper. He had hid Babe's baby in a nearby cabin and planned to give the baby boy to Kelly so that she could pass the baby off as her own. Bianca's baby was then given to Babe, leaving Bianca and her family to believe that her child was the one who had been killed.
One of Paul's crimes eventually caught up with him when district attorney Daniel Colson shot and killed Paul, who had been blackmailing him about being gay. When Daniel's lies started catching up with him, he was haunted by Paul's spirit, although it was possible it was simply a trick of Daniel's guilty conscience.