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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

AIBU or was midwife stealing my morphine?

340 replies

Morphinemidwife · 02/11/2019 12:05

Slightly longwinded background for context:
I gave birth to my DC around 6 weeks ago, ended up having a caesarian under GE so no spinal block, and a lot of complications that meant over 6 hours in surgery.
Came around in agony (spinal block apparently offers longer term pain relief), so put on a morphine pump at the request of the anesthetist from surgery and a registrar. All fine, lovely night changing and cuddling baby, some pain obviously but totally manageable and under control.

The same registrar and another Dr came later to remove the pump before ending their shift, and prescribed me 10-20ml of oramorph every 2-3 hours. Said to keep on top of the pain, as it was hard to get it gone but that it should be trivial to stop it coming back. Had first dose, few hours pass, all good still.

One midwife was responsible for me overnight, her shift starting soon after i came off the pump, she was administering my medication. She gave me 5ml of oramorph very infrequently - every 4-6 hours over the night, despite my frequent buzzing in absolute agony. By the morning I was in tears, groaning, high temperature and completely unable to move. She kept saying I should be mobile, when I couldn't move for pain. When my pain was being managed I was able to pick up my DC to change and feed etc, by this point I couldn't move to sip a drink despite being very thirsty. The midwife wrote in my notes saying I was failing to cope and look after my baby and my husband was having to take over instead. I just needed pain relief.

When the morning shift came, I asked whether I could have the full dose of oramorph as frequently as prescribed as my pain was completely unmanageable. I'd realised it had been a lost cause trying to get the correct dose overnight.
They said I couldn't, as my chart showed I'd had the maximum possible dose - 20ml every 2 hours. All signed off.

I insisted I'd had 5ml every 4-6 hours, nobody would believe me. I wasn't allowed any morphine, just paracetamol. I was in an astronomical amount of pain. This prompted a mental health referral. Overnight I had been given 15ml of oramorph, my chart said I'd had 120ml.

I had a mental health Dr come to pointedly ask me whether I had any drug problems as there was no way that dose would leave me in agony, I accused of having a mental breakdown and being "unable to cope" all day. I was accused of wanting extra morphine because I needed "an escape". I was fine, overjoyed other than the pain, just lacking any sleep and in need of pain relief. I didnt feel able to repeat my assertions that my chart was wrong to the mental health Dr, as it had prompted the referral and mutterings of SS involvement.

I ended up having to stay in hospital for 5 days, having been desperate to go home as they were concerned for my mental health because I was crying all day due to being in total pain. Being on the ward robbed me of any chance of sleep, my paracetamol wasn't even administered regularly so I only made it home when on day 5, the pain had naturally eased off a bit so I stopped crying and groaning.

Went home, giddy and happy with a new baby so thought no more of it and didn't want to focus on the negatives of the first few days.

But its just occurred to me, weeks later, how the midwife looked and was moving, her pinpoint pupils. She was taking my morphine and forging the chart wasn't she? It's bloody obvious to me looking back that it wasn't just an error like I'd initially thought.
WWYD? I could never prove it, could I?

OP posts:
Supersimkin2 · 02/11/2019 13:24

Medics do steal dope. The nurse I know of used the remainder of patients' dispensed doses to keep himself topped up. Not the whole syringe of it.

All the seniors nurses knew, as did the hospital management, and he was quietly 'transferred' to another ward. Where he carried on, presumably.

MsChanandlerBoing · 02/11/2019 13:24

Posted too soon!

An unfounded accusation would also cause her undue stress which could be avoided if you go through a proper debrief as opposed to get in the phone to PALS immediately.

ilovehalloween · 02/11/2019 13:24

Nurse friend says it's very common and often not noticed by busy colleagues

I find it difficult to believe that patients off their tits on opioids are more reliable witnesses than medically trained colleagues, busy or not.

I've been in hospital a lot and know quite a few doctors and nurses.

Ginnymweasley · 02/11/2019 13:25

Many medical professionals have told you that the dosage you believe you should have had is too much. Many people have told you to ask for a debrief first. I understand that you had a traumatic birth and first weeks in hospital. A debrief would really help with that. My spinal was messed up when I had my ds I was traumatised but the debrief really did help me come to terms with what had happened.

AnyOldPrion · 02/11/2019 13:27

Just seen your update. It’s such a difficult area. But if your husband was there and witnessed everything, then querying the dosages and time periods is easier. Not to assume she did anything, but to ask initially for clarification. If there is a discrepancy between what you and your husband witnessed, and what your notes state, then hopefully that would trigger an enquiry.

turnthebiglightoff · 02/11/2019 13:28

Nurse and midwife in family here. Having asked them, they agree with a PP that it's super rare to be given 20 straightaway and much more likely to be 10 - so 5mls.

I was on 4 hourly Tramadol after a horrible birth injury, it didn't touch the sides tbh. Was backing it up with ibuprofen and paracetamol (docs instructions!) some drugs are better than others for different people; my epidural didn't work at all but my spinal block did!!

Supersimkin2 · 02/11/2019 13:29

Medics have an auto-protect mechanism that switches on when it comes to colleagues, as does the institution that hires them. Patients don't have that vested interest.

Stoned sick people would be more reliable witnesses for malpractice any day.

Schuyler · 02/11/2019 13:29

I have no doubt that some medics do indeed steal drugs and work when under the influence. However, OP is insistent her dose is correctly and it’s just not. Even palliative care patients aren’t given morphine the way she prescribed. If she was truly written up for 20mg every 2 hours, that’s a massive omplaint in itself! That is an overdose. OP believes she should have been given 120mg in 12 hours for acute post surgical pain. That is not possible.

ilovehalloween · 02/11/2019 13:31

Just a quick google shows me

Recommended dose 10-20 mg (5-10 ml) every 4 hours.

So over 12 hours 3 doses of 5ml would be right. I'm not sure why the nurse would give you the maximum dosage unless you were a very large man or had a tolerance to morphine.

Supersimkin2 · 02/11/2019 13:31

Thanks @Schuyler.

Popc0rn · 02/11/2019 13:31

Ask the ward for a debrief.

But all the places I've worked, oramorph has been kept in the drug trolley, no need for second check or signature, so in theory we could help ourselves to a bottle, no need to steal a patients dose.

I also think if she was going to steal your drugs (don't think she did btw), she would have given you a placebo liquid of the right amount, otherwise it's pretty obvious, unless she's completely stupid and doesn't care about being found out.

Howmanychildrentoomanychildren · 02/11/2019 13:32

I would contact PALS for your own peace of mind. However I know from my own experience after C-section with heavy blood loss and on morphine that I developed intense paranoia. So that is something to bear in mind.
Glad you're now ok and home and enjoying your baby. Time in hospital is the pits.

OhDearEthel · 02/11/2019 13:32

The dose prescribed sound right to me.
Any woman having a GA section doesn't have the painkiller in the spinal injection that helps for the first 18-24 hours.
Most (where I work) get IV morphine while unconscious, a nerve block in the abdomen to make it numb for 6-12 hours and oromorph 10-20mg 2-3 hourly post op. A significant proportion also get the morphine pump.
It's major abdominal surgery, and it infuriates me how midwives play it down.

AnnaMagnani · 02/11/2019 13:32

Nurse friend says it's very common and often not noticed by busy colleagues

It's not common. It's a risk which trusts are aware of but common would be overstating it.

I work in an environment where there are a lot of controlled drugs administered in massive quantities - have never had a problem with diversion and any issues would be reported to police not covered over.

Offredismysister · 02/11/2019 13:32

It’s not good that you feel your pain wasn’t managed adequately & you probably do need a debrief.

You do sound like you don’t remember it all very well which is understandable.

You said a doctor gave you an initial dose & the medicine pot was full. I find this hard to believe as medicine cups usually hold 30mls & that’d be a whopping dose. But then after you’ve said your initial dose was sub cut, so there’s clearly some confusion.

BitOfFun · 02/11/2019 13:32

Pinpoint pupils aren't morphine thing.

catismychild · 02/11/2019 13:35

The issue here is that you were clearly in a lot of pain and the nurse did not escalate this to a doctor and get you sufficient pain relief prescribed. You absolutely have grounds for a complaint there.
Just be careful accusing her of stealing your meds, as many of us have pointed out the dose you claim to have had prescribed was highly unusual.

MaybeitsMaybelline · 02/11/2019 13:37

You were on morphine but recognised the signs of substance abuse in the midwifes pupils?

I don’t doubt your pain, but i don't think the midwife was knocking it back for herself whilst on shift to the point that you, under the influence of a similar dose, was coherent enough to recognise the signs in her.

Tiredmum100 · 02/11/2019 13:41

I'm a nurse as well. Luckily I've never come across other HCP stealing meds, I didn't realise it was so 'rife'. I would think the ormorph was most likely been prescribed on the prn side of the chart, which means you needed to ask for it. The main side of a drug chart is usually morning, lunch time, tea time and night time which are the meds given routinely every day. Then the doctor most likely would have written 10-20 mg and stated how many hours apart. Then when you asked for it the nurse would most likely have started you off on the minimum dose which is why it was 5ml. The only way to resolve this and get peace of mind is to ask for a debrief.

Schuyler · 02/11/2019 13:43

@BitOfFun
It’s dilated pupils you get on morphine, isn’t it? I always forget.

Beveren · 02/11/2019 13:45

Did you have any blood samples taken over the relevant period? Is it possible anything would have shown up on those?

Passthecherrycoke · 02/11/2019 13:46

I’m wondering what good a debrief would be though. I had one, and it was excellent- because I didn’t understand what had happened to cause a crash section and some confusion afterward.

My notes were ordered and read to me by a senior midwife who obviously had no connection to my care. She simply told me what had happened, using the notes. OP is alleging the HCP forged the notes. A senior midwife expecting a birth debrief surely isn’t the right person to meet with to allege something like this?

Morphinemidwife · 02/11/2019 13:49

@ohdearethel thank you, I didn't get IV morphine whilst under, thus - I assume - the panicked sub cut administration as I was in recovery.

My memories of leaving recovery, going on the ward and being on the pump are completely lucid. Visitors confirmed my memories of being chirpy and "with it", I spent so long being bought round that I wasn't drowsy once I hit the ward. My texts sent whilst on the pump aren't those of a confused or out of it person.

Am I supposed to believe I was secretly given an extra 5ml at every dose after noting how much I was taking as I did so?
And was secretly given 3 doses, unawares, that just happened to be the same 3 DH doesn't recall either?

This is why I'm scared to report. I know the volume of medicine I was given with absolute certainty. I didn't realise it was 2mg/ml rather than 1, there is still a huge discrepancy. I'm not keen to rehash it as I know I'll hear much of the same as on here, but I'm really bloody positive and I feel guilty about not doing anything and it happening to somebody else.

I'm not dramatising or wanting resolution, I'm thrilled and well and haven't dwelled on it until putting 2 and 2 together today. I just don't want to forget about it, and have it continue to happen

OP posts:
Span1elsRock · 02/11/2019 13:51

You sound far too aware of the doses OP.

You're going to struggle to convince anyone that you don't have substance issues, given your initial post, sorry.

I'd focus on enjoying your baby.

Loaf90 · 02/11/2019 13:53

Sounds as though you're getting mgs and mls confused Blush

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