The state of Tennessee carried out the execution of Byron Black on Tuesday morning. The 69-year-old was convicted of killing his girlfriend and her daughters in 1988. The execution was carried out despite uncertainty about Black’s heart implant.

Black was in heart failure, so he had an implant that would shock his heart if his pulse got too low or his heart went out of rhythm. That second function, defibrillation, had Black’s attorneys concerned he could be jolted by painful shocks as he dies.

Reporters who witnessed the execution said that Black seemed to be in distress during the procedure and said “it’s hurting so bad.” Journalists spoke at a press conference following the execution and said that Black was breathing more heavily and seemed to be in more distress than the execution of

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