Every second of every day, oxygen-rich blood is coursing through your brain. Your heart pumps it up through your chest and neck, along tinier and tinier arterial tubes, twisting and turning among the grooves and lobes of gray matter until it reaches the brain cells it’s meant to nourish. But this journey can be interrupted. An artery can get clogged—often by a free-floating, gelatinous clot—which halts the flow of blood. The clog will starve your brain’s cells of oxygen. Within moments, your brain’s tissue will start to die.
This is what happened to John Fetterman in May of this year, when he suffered an ischemic stroke—a type that affects roughly 700,000 people in the United States annually. Five months later, Pennsylvania’s lieutenant governor says he still struggles to process the words that he hears, and sometimes he can’t quite express what he means. For a regular person, these effects would not be newsworthy. Fetterman, though, is a candidate for the U.S. Senate. This week, NBC News’s Dasha Burns said that Fetterman seemed unable to participate in preinterview small talk conducted without closed captioning, but other recent Fetterman interviewers pushed back, saying he’d done just fine when they spoke with him.
Clearly, observers cannot agree about the degree of impairment or disability that Fetterman is experiencing. But this much is certain: His health is a legitimate consideration for the voters he is seeking to represent in Congress. And although Fetterman’s critics are framing his stroke as a liability, the Democrat is hoping that his health challenge makes him a more relatable—and therefore more appealing—candidate. The question is what voters should make of it all.
For most of the summer, Fetterman’s campaign used social media to compensate for the fact that the Democrat was unwell. On Twitter, Fetterman and his team mocked his Republican opponent, Mehmet Oz, for his many mansions and his ham-handed attempts to seem like an ordinary Pennsylvanian. They scored headline after fawning headline for their snarky social-media strategy. But the candidate himself stayed home, trying to heal.
Fetterman sounds a lot more like his old self now than he did in August, when he first returned to the campaign trail. But he still stumbles in his speech. At a rally I attended outside Philadelphia last weekend, he delivered a few applause lines and phrases that were difficult to understand; occasionally, the audience would answer with tentative claps. After the event, Fetterman did not entertain questions from reporters, and seemed unable to respond all that meaningfully to on-the-fly comments from voters; his wife, Gisele, appeared to be the one leading those interactions. But while Fetterman may not be able to do small talk, he is able to participate in interviews where he can use real-time closed-captioning, a live transcription of questions appearing on his laptop. He’ll use the same tool during the upcoming debate against Oz scheduled for October 25.
That accommodation for someone who’s recently had a stroke is the same sort of allowance that would be made for a Senate candidate who was hearing impaired. Still, it’s reasonable to ask whether Fetterman’s stroke damaged his cognition, his ability to learn and to comprehend language—and how he might function as a senator.
The campaign says that Fetterman has taken two different cognitive tests and scored “in the normal range” on both. (It has released the results of one of those tests.) But the campaign has declined to release Fetterman’s full health records. “John Fetterman is healthy. He also has an auditory-processing challenge that is still lingering from his stroke in May,” Rebecca Katz, a senior adviser to Fetterman, told me. “The only proof you need to know he can do his job is the fact that he’s doing this campaign right now.”
Still, in the absence of those records, we can only observe and guess. The phrase auditory processing is not really a medical diagnosis, Adam de Havenon, an associate professor of neurology at Yale, told me. Instead, Fetterman’s symptoms seem consistent with aphasia, a common stroke effect in which a person loses their ability to comprehend or express spoken words—sometimes both. That doesn’t necessarily indicate severe brain damage. “It’s very possible to just have trouble understanding spoken language or getting words out without any impact on cognition,” de Havenon said. This would certainly seem consistent with Fetterman’s condition, given that is able to read and respond to closed captioning. Even if Fetterman does have some cognitive impairment, “I don’t think it would be profound, in terms of what he’s doing on a day-to-day basis,” de Havenon said.
So why keep his full health records under wraps? Fetterman’s neuropsychological or aphasia test results might suggest that he is more impaired than he seems. Or maybe those records show a complicated picture—one that would be easily misinterpreted by laypeople or intentionally misconstrued by political opponents. Either way, keeping those records a secret isn’t a great look for a candidate who has suffered a serious health setback on the campaign trail.
Five months after his stroke, Fetterman is still within the poststroke recovery window. Normally, a stroke patient needs about six months for the brain to heal, de Havenon told me, and 12 months for their brain to learn how to compensate for any loss in function. Which means it’s still entirely possible for Fetterman’s apparent aphasia and his neuropsych test results to improve. “I see patients like John very frequently in the emergency department and clinic,” de Havenon said. Otherwise healthy, middle-aged people who have ischemic strokes receive treatment and generally respond quite well—including over the long term.
America’s laws have long been written, at least in part, by the elderly—the word senator actually comes from the Latin for “old man.” The average age in today’s Senate is 64—in other words, when most people are thinking about retiring, America’s senators are just getting going. But historically, some senators have been barely sentient by the end of their career.
In his early 90s, the longest-serving senator in history, Senator Robert Byrd of West Virginia, was delivering halting speeches on the Senate floor. Senator Strom Thurmond of South Carolina, still in office at 100, died a hunched shadow of his former self—although his former self had been an unapologetic segregationist.
Other senators have had health issues in office that made their jobs next to impossible: Senator Carter Glass of Virginia, who had a serious heart condition, didn’t set foot in the chamber for the last four years of his six-year term, Donald Ritchie, a former Senate historian, told me. Democrats needed California Senator Clair Engle’s vote to break the filibuster on the Civil Rights Act, but he was partially paralyzed and unable to speak because of a brain tumor. “All he could do was put his finger up to his eye,” Ritchie said. “They took that as an aye vote.” In our own time, Senator Dianne Feinstein of California is showing signs of age-related impairment: According to recent reporting, she sometimes fails to follow policy conversations or recognize her colleagues.
Several senators have had strokes in office, too, including recently Ben Ray Luján of New Mexico and Chris Van Hollen of Maryland. After Illinois Senator Mark Kirk’s stroke in 2012, aides were hesitant to discuss how he’d changed mentally, according to a National Journal profile. He returned to the chamber a year later, but his health may have played a role in his later loss to Tammy Duckworth.
This is not to compare John Fetterman’s ailment to those of senators past—or to judge the decisions of the lawmakers who have stayed in office past their prime. But the Senate is familiar with disability—brought on by age or any number of other factors. It has and will accommodate it. If Fetterman is elected, Ritchie told me, the secretary of the Senate will help organize the tools he’ll need for a committee hearing or floor speeches. Given how manageable these measures are, the Fetterman campaign could be more transparent about what the Democrat’s everyday life as a senator might look like.
None of this can be easy for Fetterman. Less than a year ago, he was discussed by voters and journalists alike with something akin to awe: A 6-foot-8-inch man in a hoodie, with a goatee and tattoos, is not your typical political candidate; despite his relatively privileged upbringing, Fetterman was the straight-talking everyman, the guy with the irreverent vibe. Back then, the biggest question surrounding his campaign was whether he’d show up to the Senate in cargo shorts.
Fetterman may still be all of those things, but now, he is also a man wrestling with an uncooperative brain. And the entire country is watching, making note of his every pause and stammer.
“We are pulling back the curtain on his recovery,” Katz from Fetterman’s campaign told me, “and having worked in the Senate and seen firsthand how many senators cover up their various challenges, I can tell you that this is refreshing for people. He is being very honest about the challenges he’s facing at this moment.”
Even if his campaign could have been more forthcoming earlier about his condition, it is true that Fetterman has found a way of talking about it since he returned to the trail in late summer. Near the beginning of his stump speech, he asks: “How many of you have had your own personal health challenges?” And every time, nearly every hand in the audience goes up.
Last week, I traveled to Bristol to see Fetterman in action. “I’ve had a hemorrhagic stroke, which is worse,” Jeanette Miller from Bristol Township told me with a shrug when I asked her whether Fetterman’s stroke gave her pause. Rob Blatt, a retiree from Feasterville, looked at me blankly when I asked him the same. “I’ve beaten cancer and a whole bunch of other stuff,” he said. “He’s one of us—a working man trying to do the right thing by his family, his community, and his country.”
A younger fan, Eric Bruno from Levittown, told me he’d worked with people who’d had strokes. “Outwardly, it takes a while to come back. But inwardly you’re still the same person,” he said, adding, “I trust the people around him.” Again and again I asked Fetterman’s supporters about his stroke, and they all responded the same way: So what? Fetterman’s point—that knowing what it’s like to go through a major health challenge, to live with a disability, and to navigate the thorny thicket of the American health-care system can be assets for a Senate candidate—seemed to land well with his supporters. If our elected leaders are supposed to represent us, the Democrat seems to be asking, shouldn’t they be representative of us?
Oz has been closing the gap with Fetterman’s slightly higher poll numbers in recent weeks, but this tightening of the race may owe more to the imminence of the election than to sudden doubts about Fetterman’s health. After weighing their options, Pennsylvanians appear to be sorting themselves into their partisan corners; politically, Pennsylvania is very evenly split. Fetterman’s cognitive ability may ultimately weigh less with Keystone State voters than the simple fact that he is a Democrat, not a Republican.
“I will admit, it wasn’t the best speech I’ve ever heard,” Bobby Summers, a local IT manager, told me after the Bristol rally. He stood next to his wife, Lara, and their baby son on the grassy lawn where Fetterman had just been. “I don’t need a golden tongue,” Lara cut in. “I just need someone who gets the job done and breaks the tie.”