Christa Pike, 50, was sentenced to death in 1996 at age 18 for the 1995 murder of 19-year-old Colleen Slemmer in Knoxville, Tennessee. Pike and her then boyfriend, Tadaryl Shipp, killed Slemmer at a job training camp; a satanic symbol had been carved into Slemmer's chest. Pike would have been the first woman executed in Tennessee in more than 200 years, the last being in 1820 according to the Death Penalty Information Center. The execution path was a legal whipsaw. Governor Bill Lee denied Pike's clemency request earlier this week. Sixth circuit court of appeals judges temporarily blocked the execution Wednesday, but the US Supreme Court overturned the stay, clearing the procedure to proceed. Amnesty International had long argued Pike should be removed from death row, citing childhood rape, sexual and physical violence, abuse, and neglect, and noting that her court-appointed lawyers failed to present mitigating evidence at trial. Tennessee uses a single-drug protocol: one injection of pentobarbital, a barbiturate. Richard Levy, professor of anesthesiology and pediatrics at Stanford University School of Medicine, explained the intended mechanism — pentobarbital renders the inmate unconscious within seconds to minutes, induces apnea (cessation of breathing), which causes hypoxia, and ultimately cardiac arrest. But Levy noted it may not always induce apnea if the dose is insufficient or the injection misses the vein, in which case the injection will likely not result in death. That is precisely what appears to have happened. Pike was given two lethal injections late Wednesday. She survived both. Witnesses reported she was still breathing after the second attempt; some stated she was heard to snore. She was taken to a hospital. The Tennessee department of correction stated it "followed every step of the State's lawful, established execution protocol" and noted the protocol "does not allow for additional procedures beyond what was carried out this evening." No official explanation was provided for the failure. Clive Stafford Smith, founder of Reprieve with 25 years of death row work, offered two probable explanations to Al Jazeera: the drugs could have been out of date — a recurring risk given pharmaceutical companies' reluctance to supply execution drugs — or there were difficulties administering the injections, since doctors are not involved in the process. Levy called it another botched execution and further evidence that lethal injection needs re-evaluation, stating: "Either eliminate lethal injection entirely or engage medical experts to guarantee the product." The drug itself carries its own political history. Pentobarbital was removed from the federal execution protocol by the Biden administration over concerns it could cause unnecessary pain and suffering. The Trump administration subsequently reauthorized it. The gap between pharmaceutical-grade medicine and state-administered killing was already well documented; Pike's case collapses it into a single night. Governor Lee has halted Tennessee's remaining executions for the rest of the year and ordered a "comprehensive, third-party review to determine exactly what occurred." Pike's legal status remains unclear — whether she will face execution at a future date is unresolved. The system designed to deliver finality instead delivered ambiguity, with no protocol for what comes after failure.