The execution at Riverbend Maximum Security Institution in Nashville was set for 10 a.m. but was pushed to the evening by a last-minute legal fight. Pike received a dose of pentobarbital at 7:40 p.m. and a second at 8 p.m. Her legal team confirmed she was still alive afterward. A media witness reported hearing her "loudly snoring about one hour after the procedure had started," and emergency services were called at 8:40 p.m. She was taken to a hospital by ambulance. The Tennessee Department of Correction said state protocols did not allow further attempts after the two doses.

Pike's attorneys said the IV team took more than an hour to set lines and used at least seven needles; another report put the figure near 10. They said her arms were swollen, bruised and blistered, possibly from the drug leaking into tissue. One attorney described her hands as looking like "blown up surgical gloves." She was intubated and on a ventilator for several days and was diagnosed with pneumonia and a blood clot. She returned to prison on October 10, having recovered enough to stand and walk.

She is now held in isolation in the medical ward of the Debra K. Johnson Rehabilitation Center in Nashville, which she compares to her previous 28 years in solitary confinement. In her statement, released through her lawyers, she wrote: "My body hurts. My arms hurt. My hands hurt. My throat hurts. I still struggle to speak." She said she "woke up alone in a hospital confused and in pain," had been "prepared to die," and does not know why she survived. "Healing is not the same as being OK," she wrote. She thanked her legal team and medical personnel, and she reflected on the pain of her victim's family.

Pike was 18 when Colleen Slemmer, a 19-year-old classmate, was killed near the University of Tennessee campus in Knoxville. According to one account of the case, Pike and her then-boyfriend, Tadaryl Shipp, lured Slemmer to a remote area of the campus, beat her for 30 minutes and struck her head with asphalt. Shipp was 17 and ineligible for the death penalty, so he received life in prison. A third participant, Shadolla Peterson, testified against both and received probation. At trial, forensic anthropologist Dr. Murray Marks presented a piece of Slemmer's skull that Pike had kept, saying it "fit precisely."

Slemmer's mother, May Martinez, witnessed the attempt. "It was a mess," she said. She has said the state owes her an apology and that the focus on Pike's condition has distracted from her daughter.

Pike's lawyers have asked that her sentence be commuted, saying she "endured punishment greater than any other person in the history of the American death penalty." Attorney Steve Ferrell has urged the governor to act. Governor Bill Lee, whose term is ending, has paused executions in Tennessee through the end of 2026 and ordered an independent third-party review. Frank Strada, the Department of Correction commissioner, resigned. Lee's office said Pike remains incarcerated and that her sentence stands unless the courts decide otherwise.

Robin M. Maher, executive director of the Death Penalty Information Center, called it "the worst we've ever seen and unlike any other botched execution in the modern era." It is Tennessee's second execution problem this year, after Tony Carruthers received a reprieve because of difficulty with IV lines. Reporting on the state's lethal injection protocols has found they have grown increasingly vague since 2007. A Reuters/Ipsos poll in October found that one-third of Americans support a second attempt to execute Pike.