She Was Executed Twice. Then She Started Snoring.

On the evening of September 30, 2026, at the Riverbend Maximum Security Institution in Nashville, Tennessee, 50-year-old Christa Pike was strapped to the execution gurney. She had been sentenced to death for the 1995 torture and murder of her classmate Colleen Slemmer, a crime committed when Pike was 18. She had spent nearly three decades on death row. If everything had gone according to plan, she would have become the first woman executed in Tennessee in more than 200 years.

Nothing went according to plan.

Seven needles

The execution team began trying to establish IV access in Pike’s left arm at around 7:30 p.m. According to her attorney, Randy Spivey, who watched the procedure, he counted at least seven needles used by the team. One of them was bent when it was pulled out of her arm. Establishing IV access took nearly an hour.

Pike was not uncooperative. According to her attorney, she kept telling the operators, “Try higher up, above my shoulder. I think it will work there.” After the first dose was injected, she even thanked the execution team.

But things were going wrong from the start. Pike complained that “my arm feels like it’s about to burst,” and said a certain spot “really hurts.” She kicked her legs so hard that she kicked off the sheet covering her. Her right arm began turning purple after the second injection, and the injection site developed blisters and burn marks.

After the first dose of pentobarbital went in, she did not die. Under Tennessee’s protocol, the team proceeded with a second dose. She still did not die. Instead, media witnesses heard her snoring and saw her raise her head to ask a correctional officer whether her arm was supposed to feel that way.

Nearly another hour passed. At around 8:53 p.m., witnesses were asked to leave the execution chamber. An ambulance with flashing lights left the prison and took Pike to a hospital.

That night, Pike’s attorney said in a statement that she was “receiving resuscitative treatment” and that her condition was unknown. Tennessee Governor Bill Lee then halted all remaining executions in the state for the rest of the year and ordered a full review by an outside party.

Robin Maher, executive director of the Death Penalty Information Center, called it “the most serious failure we have seen, unlike any other botched execution in modern society.”

Where did the drug go?

Two lethal doses of pentobarbital went in. Why didn’t she die?

Several medical experts gave the same answer: the drug most likely never entered her bloodstream. According to medical experts cited by The New York Times, the most likely explanation is “IV infiltration.” The drug did not enter the vein. It leaked into surrounding tissue.

Dr. Mark Heath, an assistant professor of anesthesiology at Columbia University, pointed out that the severe pain Pike complained about was itself a sign of IV infiltration. Dr. Joel Zivot, a professor at Emory University School of Medicine who was hired by Pike’s legal team as a medical expert, said that the concentration of pentobarbital in Pike’s blood likely never reached the level needed to cause respiratory arrest and cardiovascular collapse.

There are several reasons IV infiltration can happen.

Pike already had poor venous conditions. She suffered from thrombocytosis, a blood disorder that affects normal clotting and circulation. Her attorney had previously raised this concern with the state and asked for her execution to be carried out by hanging or firing squad instead. The request was denied. Forensic experts noted that in a small or fragile vein, a catheter can easily fail to stay inside the vein. The drug then flows into surrounding tissue rather than blood.

The execution team’s level of expertise was also questionable. The American medical establishment has long opposed participation in executions, and major medical associations explicitly prohibit doctors from taking part. This makes it difficult for states to find personnel with professional IV insertion experience. Who exactly established the IV line during the execution, and what qualifications that person had, remains unknown to the public. This is the part of Tennessee’s execution procedure that has long been shrouded in secrecy.

The drug’s properties made the problem worse. Pentobarbital is highly alkaline. If it leaks into tissue, it can cause chemical injury. That could explain the blisters and burns on Pike’s arm.

A supply chain cut off at the knees

To understand how Tennessee reached this point, one has to go back to the “drug crisis” that has gripped American execution methods for nearly two decades.

The traditional American lethal injection protocol is the “three-drug protocol.” The first drug is a sedative to render the prisoner unconscious. The second is a muscle relaxant to stop breathing. The third is potassium chloride to stop the heart. In theory, this protocol can carry out an execution relatively smoothly. The problem lies in drug supply.

Since around 2010, nearly every major pharmaceutical company has refused to supply drugs for use in executions. The companies’ stated reason is blunt: their products are meant to save lives, not take them. Pfizer, Fresenius Kabi, and other pharmaceutical giants have written to states explicitly restricting the use of their products in executions. The European Union has gone further, legislating a ban on exporting drugs to the United States that could be used in executions.

This directly broke the supply chain. Tennessee, Idaho, and several other states have had to pause executions because they could not obtain drugs through legal channels. Idaho spent about $200,000 between 2023 and 2025 to purchase execution drugs, only for all of them to expire. To circumvent pharmaceutical companies’ restrictions, some states turned to overseas manufacturers and small “compounding pharmacies,” making the procurement process completely opaque. Tennessee went further. In late 2024, it obtained pentobarbital from an “anonymous source” and announced a shift to a single-drug protocol.

The logic of the single-drug protocol is to use one large dose of pentobarbital to accomplish both sedation and death. Tennessee’s protocol is to inject 100 milliliters of pentobarbital at a concentration of 50 milligrams per milliliter, 5 grams in total. The lethal dose of pentobarbital for most adults is roughly 2 to 10 grams, meaning the state was using a dose near the upper limit.

In quantity, the dose was more than enough. But the problem is that the single-drug protocol stakes everything on one step: the injection must go accurately into a vein. There is no backup line and no fallback if the injection fails. When Tennessee adopted this protocol in 2024, Pike herself filed a lawsuit questioning the use of pentobarbital, the lack of transparency, and the absence of emergency medical plans. Her fears were all realized.

What had happened before

Botched lethal injections are not rare in the United States. Since the first use of lethal injection in 1977, execution failures caused by failed IV access, equipment malfunctions, and drug problems have occurred repeatedly.

In 2022, when Arizona executed Clarence Dixon, the execution team spent 25 minutes failing to establish IV access and ultimately used a “cutdown” procedure to insert a catheter through the groin. In 2014, in the execution of Clayton Lockett in Oklahoma, IV infiltration prevented the drug from effectively entering the bloodstream. Lockett struggled and writhed on the gurney for more than 40 minutes before dying of cardiac arrest. In 2024, Idaho’s Thomas Creech experienced an hour-long failure to establish IV access, and the execution was ultimately called off.

But Pike’s case is still emblematic. According to the Death Penalty Information Center, previous failures mostly occurred during the IV access stage. The execution was stopped before injection even began. Pike is the first known case in which a prisoner survived after the drug had already been injected.

Tennessee has already had a second failed execution this year. The previous one also involved similar IV access problems. While halting executions and promising a full review, Governor Bill Lee’s prospects for the review are not encouraging. In 2012, Tennessee also paused executions over drug problems and launched a review. That review dragged on for six years.

A different way of doing it

A contrast with the United States is China’s approach to lethal injection.

China began promoting lethal injection in 1997, expanded its use starting in 2001, and equipped courts in some regions with dedicated execution vehicles. During the execution, correctional police restrain the prisoner on an injection bed. A forensic examiner or trained personnel establishes IV access. A syringe pump then automatically injects the drugs into the vein at a set rate.

China mainly uses a “three-drug protocol.” Under professional operation, the drugs can carry out the execution relatively smoothly. The process includes heart monitoring and confirmation of vital signs, ensuring the execution is completed in a regulated manner within the legal framework.

This execution method also faces criticism. At least at the step of establishing IV access, professional staffing and dedicated equipment greatly reduce the risk of operational error. The United States, by contrast, has structural deficiencies in both dimensions: professional participation and equipment development. The medical community does not participate. Medical device manufacturers are unwilling to develop execution-specific equipment. Execution teams can only rely on experience and essentially “blind sticks.”

A contradiction that cannot be avoided

One misplaced needle did not cause this. The chaos has a structural cause: a system that tries to make executions look “dignified” in an institutional environment where no professionals are willing to participate.

The medical community opposes doctor participation in executions, so execution teams lack professional IV insertion skills. Pharmaceutical companies oppose the use of their products in executions, so states can only buy drugs through gray channels, with no guarantee of quality. This “dignity” is itself an illusion. The executioners have not enough professional training or oversight, and there is no alternative.

Tennessee pushed this contradiction to its extreme. It used the largest possible dose of an anesthetic and bet that one injection would kill. That is not an execution. It is a gamble.

Pike is still in the hospital, her condition unknown. Her legal team has asked the governor to commute her sentence to life without parole on the grounds that she suffered “chemical torture.” If she ultimately survives, Tennessee will face an awkward choice: spend years refining an execution protocol that has already failed repeatedly, or admit that the system cannot work and be forced into institutional change.

Even if she ultimately dies in the hospital, the case has already torn away the thin veneer of “civilization” from the surface of American capital punishment. As Pike’s attorney Spivey put it: “Tennessee has once again proven that it is incapable of carrying out an execution in a manner consistent with basic human dignity.”

That sentence may be the only accurate statement of fact in the entire affair.