Fetterman vs. Oz Senate Debate

My brief take on competence and cognition.

I watched most of the debate tonight between John Fetterman and Mehmet Oz. I live in Philadelphia, Pennsylvania, and I will be voting. I’m going to keep my political views out of this brief post. Instead I want to simply comment on John Fetterman’s “performance.”

Frequently I see people in the office who have suffered from strokes. Some have lost strength on one side of the body, or have been partially paralyzed. Others have lost the ability to form words and sentences. Some strokes can be terribly cruel, while other events can be mild and recoverable. It takes real courage, toughness, and patience to endure what may come, and what may not come back.

John Fetterman’s pattern of speaking sounded very familiar to me. I can think of at least 5-10 of my current patients who speak in a similar manner - halting, stumbling at times, but with an unmistakable preservation of deeper cognitive processes. If I listen, and allow for the choppiness, it sounds fluent to me. I had no trouble understanding the gist of each of Fetterman’s answers, and where he stands on the political, ideological, and moral issues of the day.

The parts of his brain that handle auditory processing are not up and running to full capacity. The usual back and forth of an argument between two people felt syncopated instead of on the beat. To accomodate for his auditory problems, the debate format allowed him to read the moderators’ questions (and presumably Mehmet Oz’s responses and challenges) off a teleprompter in real time. But like most crappy debates in the modern era, candidates were given strict 10, 15, and 60 second time budgets to respond before being cut off, or dinged by a buzzer that must have been disorienting, especially for Fetterman. His relative disability was partially accommodated, and partially exploited by this multimedia, interruptive format.

In a lot of ways I understood Fetterman’s answers better than I understood Oz’s. Stripped of eloquence, he was forced to answer with imperfect simplicity. Debates are theater and manipulation, and there he stood under the bright lights without the usual verbal make-up and costume, delivering as best he could. Anyone watching who has had a stroke, or has had a family member or friend suffer a stroke, probably felt a good mix of cringing anxiety and proud determination. It can take a year plus for the brain to recover what it will after a stroke, and with a good team around him to help with communication, Fetterman looked fine to me in terms of cognitive abilities and the intactness of his core personality and beliefs. From this distance, I agree with his physicians. He could do the job.

Mehmet Oz was able to communicate effectively, but his cognitive competence was not in question. I did not recognize him as a physician. As a doc, I have interacted with other docs, constantly, for more than 20 years. Oz continues on a journey from cardiothoracic surgeon (the skills and rigorous training of any surgeon command instant respect from me), to a kind of pseudo-primary-care-celebrity doctor, to a purveyor of products and endorsements and media that have made him incredibly rich… to this stage of running for Senate toting a gun in advertisements, and debating about how “local political leaders” should insert themselves in a decision huddle between a pregnant woman and her doctor. Politically fair game. But as a doctor?

Current PA Senator Pat Toomey (R) tweeted after the debate:

Anyone watching today could tell there was only one person on that stage who can represent Pennsylvania in the U.S. Senate: @droz. It’s sad to see John Fetterman struggling so much. He should take more time to allow himself to fully recover.

I was watching. As a physician I can tell that both Fetterman and Oz could competently represent Pennsylvania in the Senate.

It’s not “sad” to see John Fetterman struggling so much. To me, and most other people who have seen a loved one struggle, it’s instead inspiring to see him up there on a national stage debating a former surgeon only 5 months into his recovery. It’s terrifying to think a stroke can happen to any of us, and Covid is making that risk go up actually.

Fetterman’s journey, like many other patients’, is not about simply “taking more time to allow himself to fully recover.” He will probably always have some residual difficulty with auditory processing and his patterns of speaking. For most people who have had a heart attack, stroke, car accident, cancer, neurodegenerative disease, or other serious medical illness, waiting around for a “full recovery” is not a viable part of the healing process. The most courageous of us get up and keep going with whatever we have left, and with whatever productive time we are given.