Pennsylvania has one of the most contentious Senate races in the country this term, and on Tuesday night, during the one and only debate between candidates, eyes were on Democrat John Fetterman, who had a stroke in May just days before his party’s primary. After taking three months off to recover, Fetterman returned to the campaign trail, and the debate was one of the highest profile appearances he’s had since.
It did not go particularly well for the Democrat: 53-year-old Fetterman struggled to communicate while facing off his Republican challenger Mehmet Oz, missing words, repeating himself, and pausing to collect his thoughts throughout the debate. In the aftermath, members of the media and Republicans alike have expressed doubts about his health and questioned why he agreed to a debate in the first place.
The Fetterman team tried to set expectations low before the debate, framing their candidate as someone who has never been a natural debater, and emphasizing that he is still in recovery mode. In a memo sent to journalists ahead of the big event, they admitted debates were not, “John’s format,” and, “if we’re all being honest, Oz clearly comes into Tuesday night with a huge built-in advantage.” Fetterman’s doctors, however, have repeatedly said he is capable of taking on the full workload that would be required of him in public office.
Some of Fetterman’s visible issues were directly explained by the moderators: As a result of his stroke, Fetterman was given closed captioning for both questions and answers. It’s a common accommodation for stroke patients to help with auditory processing issues, and has been unfairly questioned. Prior to the debate, Fetterman’s doctor explained that the condition can come across as hearing difficulty, but that the pauses and delays actually signal a word was not processed properly. The issue was that on the debate stage, and with time limits and an opponent and moderators occasionally interrupting, these delays resulted in Fetterman often struggling to clearly express himself or articulate his positions succinctly. The question became: Is this the result of a processing problem, or could it be signaling some greater impairment than what his campaign has disclosed?
To answer that question, I talked to two doctors about how we should view Fetterman or assess his abilities, after watching him debate. Kevin Sheth, director of the Yale Center for Brain & Mind Health, told me it’s clear that Fetterman’s stroke was significant—but it’s also evident he’s made significant progress in the past five to six months since. He’s not only been continuing to campaign but was able to participate in last night’s debate, get on stage, and get into extended question and answer sessions. To Sheth, “that says something, clearly he does have some challenges still with his speech and his language, but those in some ways are not unexpected.”
The aftermath of stroke recovery varies greatly depending on which section of the brain was impacted and how severe it was. The American Stroke Association boils it down to: if a stroke occurs in the left side of the brain, the right side will be affected and that includes speech and language problems, though Fetterman’s campaign hasn’t shared specific details on the extent of his stroke. Paralysis and memory loss are also potential symptoms that can impact strokes that happen no matter which side of the brain the stroke occurred on.
Pooja Khatri, division chief of neurology and rehabilitation medicine at the University of Cincinnati, told me Fetterman pushing through his impairments could actually help with his stroke recovery. She explained that it’s a principle of speech therapy—a form of rehab Fetterman’s doctor has confirmed he’s been attending on a regular basis. However, stress can make recovery more challenging, Sheth noted, adding that that’s something the job of a senator usually comes with.
Taking all of that into consideration, Sheth said he thinks Fetterman appears to be doing OK! Sure, he has some lingering auditory processing issues, but Sheth thought his ability to get into complex responses during Tuesday night’s debate should be viewed as reassuring, even if he was noticeably slower than his opponent (who is, to be fair, a TV veteran). Generally, the first three months following a stroke are considered the most important for recovery and when patients see the most improvements, and Fetterman is about five months post-stroke. But Sheth doesn’t think that means Fetterman is at the end of his road to recovery—he said there’s certainly still potential for more progress.
Many people who experience strokes end up with some level of disability—in fact it’s considered a leading cause of disability in the U.S. It’s possible that Fetterman will continue to struggle with processing, but it shouldn’t be viewed as a proxy for his cognition or thinking. When I asked about the reaction to Fetterman’s performance, Sheth thought that it was a reflection of American society’s preconceived judgements, “We definitely often have biases against a range of disabilities and I think that’s what you’re seeing play out here,” he said.
Strokes are pretty common in America, with someone experiencing one every 40 seconds. In fact, there are currently two other Democratic members of Congress who have also experienced strokes: New Mexico Senator Ben Ray Luján and Maryland’s Chris Van Hollen, who experienced his stroke the same day as Fetterman. Both Congressmen recovered and continue to serve their respective offices.
Some recognized the feat that it was for Fetterman to not only publicly recover from a stroke but chose to participate in a nationally televised debate and the decision may have actually boosted his Senate campaign. Even with all the discourse, it’s worth noting that within three hours of Tuesday night’s debate, Fetterman raised $1 million. In fact, he’s has pretty consistently raised more money than Oz during their senate bid. Perhaps his own bet—that being transparent about his incredibly common health struggle—is the strategically sound approach after all.