What is it like to survive an execution by lethal injection?

The guards put Smith in handcuffs and leg irons, then led him to the execution chamber and strapped him tightly to the gurney. As he lay there, he prepared himself for imminent death.

Then the IV team left the chamber, leaving him in that position for several minutes. On their return, they righted the gurney.

But these are not normal times, especially in Alabama.

A recent series of disturbing death chamber encounters, in Alabama and other states, following a troubling history, has put the spotlight back on lethal injections as the main method of capital punishment in the US. The confluence of stories has been so alarming that some observers have begun to wonder whether the narrative that has stood for more than half a century that lethal injections are a medically informed, dignified way for states to kill people is finally unraveling.

The procedure was first proposed by a medical examiner in Oklahoma in 1977 as a more civilized, painless alternative to the electric chair and firing squad. But from the start, it has been dogged by problems ranging from controversies surrounding the pharmaceutical drugs used in the cocktail to prolonged and potentially agonising deaths.

Not only have death penalty states struggled to acquire execution drugs under a global boycott by drug companies, but they have also found it hard to contract skilled medical practitioners to administer the IV lines. Both the American Medical Association and the American Board of Anesthesiology prohibit their members participating in executions.

As a way around these hurdles, many states have wrapped themselves in a veil of secrecy to avoid public scrutiny. In Alabama, the members of the execution team are kept strictly anonymous.

As a result, the only people who know precisely what happened to Smith inside the death chamber are the prisoner himself and his unnamed executioners.

The prisoner, still alive but riddled with holes and profoundly traumatized, was returned to his cell. He had been strapped to the gurney for four hours.

Smith is one of only two people alive today who have survived an execution procedure in the US. His fellow member of this exceptionally small and undesirable club, Alan Miller, was subjected to an attempted execution by Alabama in September.

Miller has been on death row for 22 years for shootings that killed three co-workers in 1999. At 10pm on 22 September, he was taken into the death chamber at Holman and put through what his lawyers claim was physical and mental torture.

Alabama ignored the request.

Like Smith, Miller was also swung vertically, suspended in the crucifix position, albeit with his head up, for an estimated 20 minutes. By the time they lowered him, blood was leaking from his wounds.

In a rare personal account, Romell Broom self-published a book, Survivor on Death Row, in which he described being poked for two hours by Ohio executioners in September 2009 before the procedure was aborted.

According to Broom, who was convicted of raping and murdering a child in 1984, he was probed more than 100 times all over his body by officials unsuccessfully seeking a vein.

After the failed execution attempt, the authorities kept at him, setting a new death warrant for June 2020.

Back in Alabama Joe Nathan James was executed in July for the 1994 murder of his ex-girlfriend.

Bernard Harcourt has also seen the results of a botched procedure in Alabama up close. A Columbia University professor and death penalty lawyer, Harcourt represented Doyle Hamm, who on 22 February 2018 became the first Alabama prisoner to survive attempted execution.