October 12, 2022
John Fetterman, Pennsylvania's lieutenant governor and Democratic candidate for U.S. Senate, suffered a stroke on May 13, just days before winning the state's primary election. After being notably absent from the campaign trail over the summer while recovering, he has since returned to holding large rallies and one-on-one interviews ahead of the general election on Nov. 8.
The stroke was caused by a blood clot due to Fetterman's heart being in atrial fibrillation for an extended period of time. Fetterman's wife, Gisele Barreto Fetterman, noticed he wasn't feeling well while the two were on their way to a campaign event and took him to Penn Medicine Lancaster General Hospital.
There, doctors were able to clear the blood clot and reverse the stroke, Gisele said in a video posted on Twitter ahead of the Pennsylvania primary. On May 17, Fetterman had another surgery to insert a pacemaker and a defibrillator, this time to treat the candidate's cardiomyopathy, a condition that can be deadly if left untreated.
After winning the primary, Fetterman abruptly left the campaign trail and was unable to give interviews or speeches in the early days and weeks of his recovery. He instead opted for doctor-prescribed walks around his community in Braddock, Allegheny County.
Fetterman's campaign told New York Magazine that Fetterman's cognitive abilities were not damaged by his stroke, and the biggest impairment was the development of auditory processing and word retrieval issues.
Auditory processing issues and other speech pattern problems are common side effects after a stroke has occurred, according to the U.S. Centers for Disease Control and Prevention. The rehabilitation process, which can take months depending on the severity of the stroke, includes speech therapy, which assists patients in repairing or living with speech issues.
Dr. Leah Croll, a neurologist at Temple University Hospital and professor of clinical neurology at the Lewis Katz School of Medicine, said that while changes in speech are more common in stroke patients than auditory processing issues, they are both highly common symptoms that often require therapeutic treatment, depending on the severity of the stroke.
"The way a stroke manifests is completely dependent on what part of the brain was affected by the stroke," said Croll. "Patients who had a stroke particularly in the left side of the brain may be more likely to suffer from difficulties with language. Usually, patients are able to achieve some degree of recovery and the extent to which a patient recovers is very individualized and dependent on how severe the stroke was (and) what else is going on medically with the patient."
Auditory processing issues can be a symptom of stroke, particularly if the temporal lobes of the brain were impacted. Though some patients can recover entirely on their own, others may require more intensive therapies or medical interventions to assist them.
The underlying causes of strokes — like Afib, high blood pressure, and high cholesterol, for example – are often identified and treated with the main goal of preventing future strokes, Croll said. However, treatment of the symptoms are meant to provide a way for patients to regain independence and achieve recovery.
"I think it's important to know that auditory processing and difficulties with language are two separate problems," Croll said. "It's also important to know that having difficulties with auditory processing or language does not imply anything about cognitive function."
Fetterman's auditory processing issues have been a focus of the U.S. Senate race, particularly in recent weeks, as interviews with NBC News and New York Magazine shed light on how the candidate has managed to return to the campaign trail amid concerns over his health.
In his interview with NBC News, released on Tuesday, Fetterman occasionally stuttered and had trouble finding words. Though the interview was taped in person at Fetterman's home, Fetterman utilized closed captioning on a computer screen in order to read and respond to the reporters' questions in real time.
The candidate told NBC that his stroke and subsequent recovery "changes everything" about his day-to-day life, including how he interacts with loved ones and voters on the campaign trail. When asked about why he has not released his medical records — a major focus of the high-profile campaign — he noted that he has disclosed all of the known information with the public, including his auditory processing issues.
In September, Fetterman agreed to an upcoming debate with Republican candidate Mehmet Oz on Oct. 25, just two weeks before Election Day. He requested the use of closed captioning monitors, which have been used by Fetterman during face-to-face interviews with reporters since he returned to the campaign trail earlier this fall.
Concerns over Fetterman's use of closed captioning software to participate in interviews has resulted in some controversy among disability rights activists, who take issue with media representations of Fetterman's auditory processing issues as a disqualification.
"Recovery certainly happens upfront, but is ultimately a slow-growing process that occurs over the course of months," Croll said. "Accommodations totally depend on an individual's needs. In some cases, they may require written supplements to spoken words, or a little bit of extra time to process what they have heard."
Fetterman reiterated to both NBC News and New York Magazine — as well as through campaign messaging on Twitter — that he is fit to serve as Senator, as his cognitive function and memory have not been impacted by the stroke.