By Aidan O’Donnell
How hard is it to execute someone humanely? Much harder than you might think. In the United States, lethal injection is the commonest method. It is considered humane because it is painless, and the obvious violence and brutality inherent in alternative methods (electrocution, hanging, firing squad) is absent. But when convicted murderer Clayton Lockett was put to death by lethal injection in the evening of 29 April 2014 by the Oklahoma Department of Corrections, just about everything went wrong.
Executing someone humanely requires considerable skill and training. First, there needs to be skill in securing venous access. Some condemned prisoners have a history of intravenous drug use, which obliterates the superficial, easy-to-reach veins, necessitating the use of a deeper one such as the femoral or jugular. Lockett was examined by a phlebotomist—almost certainly not a doctor—who searched for a vein in his arms and legs, but without success. The phlebotomist considered Lockett’s neck, before resorting to the femoral vein in his groin.
Second, there needs to be skill in administration of lethal drugs. The traditional triad of drugs chosen for lethal injection incorporates several “safeguards”. The first drug, thiopental, is a general anaesthetic, intended to produce profound unconsciousness, rendering the victim unaware of any suffering. The second drug, pancuronium, paralyses the victim’s muscles, so that he would die of asphyxia in the absence of any further intervention. However, the third drug, potassium chloride, effectively stops the heart before this happens. All three drugs are given in substantial overdose, so that there is no likelihood of survival, and the dose of any single one would likely be lethal. When used as intended, the victim enters deep general anaesthesia before his life is extinguished, and the whole process takes about five minutes.
Thiopental and pancuronium are older drugs, no longer available in the United States. US manufacturers have refused to produce them for use in lethal injection, and European manufacturers have refused to supply them. This has forced authorities to use other drugs with similar properties in untested doses and combinations.
Lockett was given 100mg of the sedative midazolam, intended to render him unconscious. Witnesses were warned that this execution might take longer than expected because midazolam acts more slowly than thiopental. Lockett appeared to be still conscious seven minutes later; nonetheless, three minutes after this, he was declared unconscious by a prison doctor. Vecuronium (a similar drug to pancuronium) was then administered to paralyse him, followed by potassium to stop his heart.
Journalist Katie Fretland, who was present at the execution, wrote that Lockett “lurched forward against his restraints, writhing and attempting to speak. He strained and struggled violently, his body twisting, and his head reaching up from the gurney” and uttered the word “Man”.
How can you tell if someone is unconscious? Though it is not clear what criteria the prison used to determine Lockett’s level of consciousness, the tool most widely used is the Glasgow Coma Scale (GCS). Developed in 1974 by Teasdale and Jennett, the GCS recognises something fundamental: consciousness is not a binary state, on or off. Instead, it is more like a dimmer switch, on a continuum from fully alert to profoundly unresponsive.
The GCS uses three simple observations: the subject’s best movement response, his best eye-opening response, and his best vocal response. A fully-conscious subject scores 15. Someone under general anaesthesia scores the minimum score of 3– one cannot score zero—and this is the score which I would expect Lockett to have after 100mg of midazolam. From the reports, we can infer that Lockett’s score was much higher; it was at least 8. It should never have been above 3.
The prison doctor determined that the intravenous line was not correctly located in Lockett’s vein, and that the injected drugs were not being delivered into his bloodstream, but instead into the tissues of his groin, where they would be absorbed into his system much more slowly.
Despite a decision to halt the execution attempt, Lockett was pronounced dead 43 minutes after the first administration of midazolam. It was widely reported that he died of a “heart attack”, but this is a very imprecise term. I surmise Lockett suffered a cardiac arrest, brought on by the gradual action of the lethal drugs. During those 43 minutes, Lockett was likely to be partly conscious, slowly suffocating as his muscles became too weak to breathe, and his heart was slowly poisoned by the potassium. How much of this he was aware of is impossible to estimate.
As an anaesthetic specialist, I am trained and skilful at establishing venous access in the most difficult patients. I am intimately familiar with all of the drugs which might reasonably be used, and I spend my professional life judging the level of consciousness of other people. I would seem to be an ideal person to perform judicial execution.
However, I never will. First, I consider judicial execution morally unacceptable. Second, it is profoundly unpalatable to me that the drugs I use for the relief of pain and suffering can be misused for execution. Third, I live in a country where execution is illegal. However, even if I lived in the United States, the American Medical Association explicitly and in detail forbids doctors to be involved (however tangentially) in judicial execution, leading me to question the involvement of doctors in Lockett’s execution.
Different authorities in the United States are executing prisoners using a variety of drugs in combinations and doses which are untested, and not subject to official approval. Of course, as soon as official approval for a particular regime is granted, suppliers will move to restrict the supply of those drugs for execution, and this cycle will begin again. Drain cleaner would work fine; will they go that far?
Lockett’s bungled execution should prompt us to consider some fundamental questions about lethal injection: Who should be involved? What training should they have? What drugs should they use? Where should they come from? And the most important question of all: isn’t it time the United States stopped this expensive and unreliable practice?
Aidan O’Donnell is a consultant anaesthetist and medical writer with a special interest in anaesthesia for childbirth. He graduated from Edinburgh in 1996 and trained in Scotland and New Zealand. He now lives and works in New Zealand. He was admitted as a Fellow of the Royal College of Anaesthetists in 2002 and a Fellow of the Australian and New Zealand College of Anaesthetists in 2011. Anaesthesia: A Very Short Introduction is his first book.
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Image credit: Lethal injection room, by the Californian State of Corrections and Rehabilitation. CC-PD-MARK by Wikimedia Commons.
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James Ellroy called it "unheralded masterpiece of the noir genre." It is widely regarded as one of the finest achievements of moder noir - a classic that stands with the best of Jim Thompson and Charles Willeford. It is Lethal Injection, by Jim Nisbet.
And now, almost twenty-five years after its orginal publication (1987), critics and reviewers are still taking about
Lethal Injection. Here's a new assessment on the German publication of the original novel.
Irony of Humanity. A short 20 years later, Jim Nisbet's 1987 novel Lethal Injection belongs to the classic noir book inventory.
Franklyn Royce hasn't achieved much in his life. His wife hates him because he's not ambitious enough to provide her with the standard of living she thinks she deserves. Frustrations with his marriage and job have made him an alcoholic. His own doctor's practice is lousy, so he has to earn an extra couple hundred dollars each month as a prison doctor in Huntsville, TX. Witnessing death sentences is one of the responsibilities that goes with the job. And so he meets the young, black Robert Mencken. During the robbery of a small shop in Dallas, for a whole $9, Mencken supposedly shot the shop keeper in the face several times. When the poison of the lethal injection is already in his veins, he confides in Royce that he's innocent of the crime, but prepared to die. His confession is an awakening for the doctor, and shortly before dying the condemned men seals the experience with a kiss.
Lethal Injection has long been a timeless, insider tip for those who know the genre. For Sandro Veronesi, whose article out of La Repubblica serves as forward to the new German translation, author Nisbet is a "phantom genius", little known and admired by few… but these readers are spread out all over the entire world and all in all aren't so few in number.
But don't expect that the new German edition of Nisbet's classic from 1987 will be a huge hit. That it ought to be is barely more than a fervent wish. In the local, not so badly stocked book store the Pulp-Master titles - after "
Dark Companion", “Lethal Injection" is the second Nisbet novel for the Berlin publisher Frank Nowatzki in his highly praised enterprise - are seldom requested. Too literary? Too depressing? In the truest sense of the word, too "noir"?
In any case, for Franklyn Royce the encounter with Bobby Menken starts a new and for him final phase of life. Nothing holds him in his relationship any longer. Convinced of Menken's innocence, Royce sets out on a search for the real killer. He quickly lands with the two people who were there as the murder occurred, for which Mencken was executed. Eddie Lamark is a psychopath capable of anything; Colleen Valdez a heroin addict and sometime prostitute who doesn't need to do much to totally bewitch the sexually frustrated Royce.
The reader only notices at the very end of the book the sophistication Nisbet used in composing this early masterpiece. And that the path of Franklin Royce is already laid out in the path of the man the doctor feels called to revenge. Royce won't survive his search for the truth either. The connections he finally reconstructs and tragically gets wrong is at the very end simply repeat the irony of human destiny that Mencken made Royce aware of: that it was in the hour of death that Royce finally encountered
Jim Nisbet, author of Windward Passage, Lethal Injection, The Damned Don't Die, and the forthcoming Old & Cold, recently sent us this note on what writers have influenced him most:
"That's a long list and, one way or another, it would have to include almost everything I've every read.
I've been around a long time, of course. So, for example, I read almost all of Dostoyevsky when I was 22 and maybe 23 years old. I went to my draft physical bearing a copy of The Idiot, and, basically, I never got over Dostoyevsky. Those translations were done by a woman named Constance Garnett. Now, 40 years later, we have in America a completely new and really interesting re-issue of all the novels of Dostoyevsky as translated by the team of Richard Pevear and his wife, Larissa Volokhonsky, and these translations are just terrific. As a result, to date I've reread The Possessed, The Devils, The Gambler, Notes From Underground... And, you know what? Dostoyevsky is still great.
Pevear and Volokhonsky, by the way, have made a big hit here with their translation of War And Peace. I reread that, too, but, you know what? As my friend the late, lamented Robin Cook (aka Derek Raymond; is he translated in Italy?) used to say, "Tolstoy? You can have Tolstoy." Apostasy! Sacrilege! But, well...
Stendhal (much borrowed by Tostoy); I have a collection of English translations of Le Chartreuse de Parme and reread it regularly. (My favorite one remains the first one, done by The Lady Mary Lloyd; my copy was published in 1901.) I hope one day to be able to read it in French. But I also just read La Vie de Henri Brulard. Cesare Pavese I could mention, and Curzio Malaparte -- why not? I'm talking to an Italian! I've even read Ferdinando Camon. Who can forget the entire family fighting over the anchovy hanging by a string over the dinner table? Not so much Moravia... All of Jane Austin. Most of Beckett. Moby-Dick -- what a book! A Story of A Life by Konstantin Paustovsky. All of the literature of single-handed sailing, particularly of course by the circumnavigators, starting with and often coming back to Sailing Alone Around The World by Capt. Joshua Slocum. Books on astrophysics...
But you probably want to know about thrillers. So, Jim Thompson, David Goodis, Dan J. Marlowe... which brings me to...
Chandler, Hammett, H.P. Lovecraft, Ross Macdonald ... and Kerouac. I've read much of what these guys wrote, and avidly, and years ago, and, you know what? Unlike Dostoyevsky, I've not been able to bring myself to repeat the experience. There you have it. But I very much admire The Factory Series, and that before I met its creator, the English writer Robin Cook, whom I came to count as a friend, but of whom, interestingly enough, I never read or heard of until I started going to France. He's still relatively unknown...
When I was nine and ten and eleven years old I read all kinds of Mickey Spillane and various other thrillers, A Coffin for Dimitrios, James Bond, but no more.
Christ, I forgot about Faulkner!... And never mind every book about Antarctic exploration, beginning and ending with The Worst Journey in The World, by Apsley Cherry-Garrard.... Then there's Wilfred Thesiger! And all the Voyageurs tramping North America, looking for plews and the northwest passage. A huge body of literature. Mad dudes like Celine and the Marquis de Sade...
Jim Nisbet's Windward Passage continues to received extraordinary review attention from all over the globe. Here's a new one, written by book critic Woody Haut for Crime Time, a terrific website from the International Association of Crime Writers:
"Jim Nisbet, author of The Damned Don't Die, Lethal Injection, Prelude to a Scream, Death Puppet and Price of the Ticket has long been one of my favorite noirists. In Windward Passage, his tenth book, he pulls out all the stops, combining his long-standing noir sensibilities with an off-the-wall post-modern disposition and cultural critique. Pacey, but filled with enough tropes to keep the most hardcore Jim Thompsonite happy- at least those partial to the final section of The Getaway or the surrealism of Savage Night- Windward Passage centres on a ship that sinks in the Caribbean, its captain chained to the mast. A logbook, a partially written novel, a brick of cocaine and the DNA of a President are all that remain. The appropriately named dead sailor's sister, Tipsy lives in San Francisco, where she hangs out at bars with her gay friend Quentin. That is until she runs into Red, Tipsy's brother's old employer.
Scrambling genres and voices, Windward Passage flits around geographically as well as linguistically, high-tailing it from San Francisco to the Caribbean and back again, dove-tailing from fast-talking, never-less-than-witty dialogue to tangential asides, reportage, paradoxical quips and a novel within a novel. With his ear to the ground, Nesbit not only updates the traditional noir narrative, combining it with a sea adventure story, conundrums, a dash of cyberpunk, and a sprinkling of literary concerns (including the likes of Tom Raworth, Paustovsky and Leonard Clark's The Rivers Ran East). From a prologue that will leave you scratching your head for at least a hundred pages, Windward Passage sometimes reads like a hardboiled Saragossa Manuscript, and bound to appeal to anyone looking beyond the confines of the genre. Still, I remember thinking while reading the novel that this is the sort of book we're told doesn't get published these days. So hat's off not only to Nisbet, but to Overlook Press. Because this is Nisbet at his wildest and weirdest. I'm still not sure what it all adds up to, other than an entertaining, insightful and highly recommended adventure."
Jim Nisbet, author of the noir classic Lethal Injection and newly published Windward Passage, will be signing books at The Mysterious Bookshop in New York on Friday afternoon, May 7, at 4pm. (55 Warren Street in Tribeca).
Nisbet is the author of nine previous novels, including Lethal Injection, Dark Companion, The Price of the Ticket, Prelude to a Scream, and The Octopus on My Head. His work has been published in eight languages. Nisbet has twice won the Pangolin Papers Annual Fiction Award, and thrice been nominated by for a Pushcart Prize in short fiction. His novel, Dark Companion, was shorted-listed (with four other nominees) for the 2006 Hammett Prize. He has also published five volumes of poetry.
Don't miss this rare New York appearance by one of the great masters of noir fiction!
“Jim Nisbet -- whose pen is mightier than a million swords -- does it again with Windward Passage. This is a book that should not be missed.” – Michael Connelly
“Well, it's official. In the next decade, the world will finally be weird enough to make Jim Nisbet accessible to the masses...his books have the sort of "naked lunch" effect that William Burroughs used to describe the hyper state of perception once experiences under the influence of narcotics. But you ignore Nisbet at your own peril. Because he really does know what's going on and why. He's lived in your future for some thirty years. He's still looking back. Readers would do well to look forward.” – Rick Kleffel, The Agony Column
"Jim Nisbet is a cult favorite in Europe and it's easy to see why. I've talked to a few people about this author and comparisons abound; he's Thomas Pynchon crossed with Raymond Chandler; the lovechild of Patricia Highsmith and Don Delillo, and on and on it goes. For my money I'd say he reads like Jasper Fforde meets Ken Bruen. One thing for sure, he's unique and man does he have a vivid imagination.” –SleuthOfBakerStreet.com
“Nisbet's novels... always look like one thing but turn out to be something else entirely. It is a rare talent, not accessible to all, perhaps, but no less special.” –Booklist
“Missing any book by Nisbet should be considered a crime in all 50 states and maybe against humanity. Erudite, perspicuous and sanguine...This California philosopher, etymologist and savant will take you on a trip like no other writer I know. Do not miss this one or any other of his great books!” –The Swarthmorean
“In Windward Passage, Nisbet captures the absurdities of present-day America with a rare pungency in this noir gem…Crime, cosmology, politics, philosophy, physics and more enter into this cautionary tale, which climaxes with the suddenness of a cobra strike and then delivers a denouement that's both stunning and absolutely perfect.” –Publishers Weekly
"Nisbet mixes noir mystery, dystopian sf, and a great deal of humor into a bubbling, complex stew. With his scruffy characters, political and philosophical bent, and ability to turn a striking simile, he resembles no one so much as a somewhat more subdued (no talking inanimate objects) Tom Robbins. Highly recommended." - Library Journal
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