He ordered an oxygen tank and an ambulance arrived to take Pike to the Vanderbilt University Medical Center in Nashville, where she was put on a ventilator and treated for severe burns and blistering in her arms. Later, it would become clear that the IV hadn’t been properly inserted into her veins. Sometimes the thin plastic sheath can clog or dislodge, or the push of medication can cause it to fold, Fowler says. Whatever happened in this case, “it was delivering medicine to the subcutaneous tissue” of her arms, he says, rather than her bloodstream. After ten days, she regained the ability to walk and talk before returning to the Tennessee women’s prison.
In the machinery of an execution, each participant is a cog performing a compartmentalized task, diffusing responsibility and obscuring their individual complicity. The paramedics who set the line wouldn’t have known that something went wrong with it because protocol instructs them to leave the room before the injection team enters. In turn, the Department of Corrections employees who inject the drug leave before the physician comes in. (A similar psychological ritual takes place among firing squads, where one randomly assigned gunman shoots blanks, shielding each from knowing if he delivered the fatal bullet.) Fowler’s role on the execution team that day was to pronounce Pike’s death, though in more complex cases, he is sometimes called on to place IV lines himself.
Tennessee’s lethal-injection protocol may help absolve culpability, but it can make executions faultier. Participants may be EMTs with limited medical training, or they may be prison guards with none at all. Physicians almost never agree to take part, and when they do, Tennessee prohibits them from observing the full procedure. Pike’s attorneys have cited more than a half-dozen other cases in recent years of excruciating, drawn-out executions caused by failed IVs as well as the use of untested chemicals from unnamed suppliers.
It is extremely unusual that Fowler, a 69-year-old grandfather and Sunday-school teacher in Union City, Tennessee, is known to us at all. He was publicly outed, accidentally, by a warden last year. The identities of execution participants are meant to be kept secret to protect them from social stigma, legal liability, and professional consequences. “Doctors are not lining up to do this,” says Fowler, who otherwise spends his days monitoring opioid prescriptions for chronic-pain patients and writing conservative op-eds for the Union City Daily Messenger. The American Medical Association prohibits physicians from taking any part in executions, including monitoring vital signs, inserting IVs, and declaring death, on the grounds that it violates the oath to “do no harm.” Fowler, who receives $3,000 per execution according to a deposition he gave last year, doesn’t see a contradiction between that pledge and the seven or so lethal injections he’s participated in over the past decade. For him, the work is about the fulfillment of a solemn obligation. “How can you morally say, ‘I’m for the death penalty so long as somebody else does the work?’” he says. “I do things that nobody wants to do.”
It is even more unusual that he’s providing a glimpse into the extraordinarily secretive world of American executions and the bizarre logic that perpetuates their cruelty. Fowler agreed to speak to me, he said, because I was familiar with his writing—polemic in support of ICE, Israel, and traditional masculinity, among other subjects. “I’d like to be remembered as a Renaissance man,” he tells me. “Someone who has an advanced appreciation of life.” He is inspired by Epictetus, the Stoic philosopher, and Saint Paul, who helped execute Christians before converting to the faith and then being executed himself by the anti-Christian Roman emperor. “Paul, who went through real hardship, said, ‘I have learned to become content in whatever circumstances I find myself,’” Fowler says. That included imprisonment “back in the day where there was nobody inspecting prisons for humane conditions.” In a “fallen world” of freeloaders, criminal migrants, weak men, and “race hustlers,” as Fowler has put it, he is an enforcer of tradition and individual responsibility. “There are times when you have to draw a line and say, ‘You have traversed socially acceptable norms and we must extract from you the ultimate penalty.’”
Fowler sees his career as an example of doing the “dirty work.” His father couldn’t afford to send him to college, so he worked and paid his way through law school in the early 1980s. Then he took a job as a public defender, a role few of his peers wanted. “History is replete with examples of the government pushing around and persecuting people without due process,” he says, mentioning the false rape accusations against Duke lacrosse players in 2006 as an example of why he values the constitutional right to a defense. But he didn’t like many of his fellow attorneys—they were “every bit as vile as the literature portrays them to be"—and says most of his clients were guilty. A couple of them even deserved the death penalty and didn’t get it, he adds. There were rewarding moments, such as a case involving a man who had been charged with harassing his ex-girlfriend. Fowler convinced the man to stop contacting her, got the case heard in a lower local court that doesn’t keep formal records, “and it saved that man’s job and his reputation.”
Over time Fowler’s caseload became increasingly filled with low-level domestic disputes and car accidents, and, by the 1990s, he was looking for more meaningful work. He saw an ad in the newspaper offering free tuition for physicians training in underserved areas, including his hometown, and decided to pursue a new career in family medicine. Since graduating from the University of Tennessee at Martin, he has held a string of jobs in nursing homes, jails, and hospice wards. For a while, he was a medical examiner. “I did the kinds of things where people are sick and suffering and dying that nobody wants to do because they don’t pay well,” he says. Along the way he befriended a surgeon who worked with the Tennessee Department of Corrections to oversee executions. When the man retired a decade ago, the department asked Fowler to take his place. He accepted.
On his first day shadowing an execution as a trainee, he recalls feeling nothing. “I was there to learn and observe, and I went and I learned and observed. That’s the end of that,” he says. There’s “no doubt” in his mind that the inmates he has personally helped put to death deserved their punishment. “I usually research their records and take a look at what it is they’ve done and so forth.” Over most of the next decade, he says, his work was limited to declaring deaths, and the procedures went smoothly. But everything changed in the past year as Fowler became the public face of the death penalty’s most egregious failures. First he was identified as the physician in the 2025 execution of Byron Black, whose lethal injection his attorney described as “torture.” Then, in May, he was involved in the botched execution of death-row inmate Tony Carruthers. After paramedics failed to establish traditional IV lines, Fowler attempted a semi-surgical procedure to place one in a vein near Carruthers’s clavicle, which would deliver the drug directly to his heart. Carruthers’s attorney reported seeing “a lot of blood” and hearing her client groaning in pain over the course of an hour. “There was a bit of theater in that,” Fowler says. But he ultimately stopped (“of my own volition”), not because he couldn’t do it, he says, but because he didn’t have adequate anesthetic and it was becoming too painful for Carruthers—"not to mention the fact that there are lawyers standing there taking notes and scribbling furiously.”
Fowler was roundly accused of incompetence, partly for admitting he hadn’t inserted a subclavian IV in 12 years. Carruthers’s sister sued him for malpractice, claiming her brother suffered a stroke during the procedure that led to paralysis. (He is now back in a Nashville prison on a one-year reprieve.) Fowler denies that he lacked the necessary expertise. “I have gotten it successfully several times,” he says of placing subclavian IVs at hospitals in the past. “It’s like riding a bicycle, and, frankly, the motor skills and neurological skills required to ride a bicycle are far more complex than placing an IV line.” (He called the stroke allegation “completely false.”) Now, he and the state are facing the possibility of malpractice or negligence lawsuits from Pike’s family, which one of her lawyers argues is likely. Fowler says he’s not worried—his conscience is clear.
He does not see a contradiction between his work and his evangelical Christian beliefs. He starts his mornings with devotional readings from the Book of Common Prayer and strives to be kind to others. “I like to think that I tip generously. I like to think I treat waitstaff generously. I have a housekeeper, and I have traditionally paid her more than she asked,” he says. But he has his own interpretation of the Sixth Commandment. “‘Thou shalt not kill’ does not have any application to the legitimate actions of the government in terms of executing murderers, nor does it have any application in self-defense, and it does not have any application morally in war,” he says. “When the state says, ‘We think there are some things so heinous that we should effectuate the ultimate punishment,’ I think that’s legitimate.” (The same applies when the state says those punishments should be nationally televised, he believes—as Pete Hegseth initially suggested for the firing-squad execution of Fort Hood mass shooter Nidal Hasan in December. When it comes to “Muslim radicals,” he says, “it’s time they understand that we mean business.”)
The power of the state, Fowler continues, trumps the power of religious redemption. “Anybody, and I mean anybody, could find God and accept Christ’s redemption,” he says, including Pike (though, he thinks as a Buddhist, “she’s on the wrong track”). As he sees it, his role is to enforce the death penalty as determined by the state, regardless of its moral legitimacy: “Is it unfairly administered? Probably. Is it always deserved? Not necessarily. My job is not to say ‘yay’ or ‘nay.’” In Pike’s case, he has no doubt the punishment is fair. “I lament that I am having to deal with Christa Pike, who bludgeoned another woman to death,” he says, but that’s the extent of his regret. “She is what she is.”
In 1996, Pike, then 18, became the youngest woman ever sentenced to the death penalty. She and her boyfriend at the time, Tadaryl Shipp, had lured into the woods their 19-year-old Knoxville Job Corps classmate Colleen Slemmer, who Pike claimed had bullied her and tried to seduce Shipp. Over the course of an hour, she and Shipp tortured the young woman and fatally crushed her skull with a rock.
Attorneys and anti–death penalty advocates have argued in the years since that the court should have given more consideration to Pike’s psychiatric conditions and history of severe childhood trauma. Pike was born with brain damage because of her mother’s alcohol use during pregnancy, and she was raped and beaten repeatedly between her toddler and teenage years. At 12, she attempted suicide. When it came to the murder, Pike couldn’t control her impulses, psychologist Bethany Brand wrote in a 2023 evaluation. “Unmedicated and untreated, she was not able to put the ‘brakes on’ her bipolar- and trauma-triggered emotions.” (Shipp, who was 17 at the time, received life in prison. He is up for parole in 2031.)
None of Pike’s appeals or clemency requests succeeded and she spent 28 years in solitary confinement. In January, her attorneys alleged that the state’s execution protocol would amount to cruel and unusual punishment. Pike has a blood-clotting disorder and small veins, which would make placing an IV difficult, if not impossible, and the effects of pentobarbital torturous. At one point she asked to be hanged instead. A judge denied Pike’s requests and her execution was scheduled for September 30. By that morning, she was ready to die.
Since then, Governor Bill Lee has halted all executions in the state for the rest of the year. Pike’s attorneys are now amending their case from earlier this year to prevent the state from attempting to lethally inject her again. Fowler agrees on one point: The lethal-injection protocol ought to change. Instead of pentobarbital, he prefers the older three-drug cocktail involving potassium chloride, which some states banned for being too painful but he believes is more effective. And the process should be simplified, he says, with fewer handoffs between team members and more oversight: Instead of leaving the room, “the people who place the IV lines should thereafter be observant about what’s happening with them as the medicine goes in.” Pike “complained of pain in her arm. They should have stopped and reassessed, and they didn’t.”
Fowler hopes the state will follow through on Pike’s execution, partly to provide “a sense of justice” for Slemmer’s mother, who was present at the initial attempt. He imagined how she might have questioned God — “Why couldn’t God direct a policeman to save their daughter?” These are concepts Fowler has been thinking about a lot lately, since he completed his second semester of seminary. He recalled what Job said in the bible after losing his children: “The Lord gives and the Lord takes away. Blessed be the name of the Lord.”
“People will say, ‘Why don’t you just walk away from this?’ And the answer is, that’s exactly what the advocates against the death penalty want,” he says. “They felt that if they could humiliate me I would step back from it — because I promise you, there ain’t anybody else in Tennessee going to sign up for it now — and the answer is, I cannot be pushed off a course that I find correct. I refuse to compromise.” What seems to bother Fowler is the feeling of being misunderstood. “I’m not an evil, vicious person. I’m not unscrupulous. I’m not uncaring, and I’m not incompetent,” he says. He shut down his Facebook account and tries to ignore the news. “It’s not like I’m ashamed” of the work, he says, but he is disturbed by the “calumny” he’s facing. Then again, he adds, “people said bad things about Jesus, didn’t they?”
Source: nymag.com, Rachel Corbett, October 30, 2026
"One is absolutely sickened, not by the crimes that the wicked have committed,
but by the punishments that the good have inflicted."
— Oscar Wilde
but by the punishments that the good have inflicted."
— Oscar Wilde
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