Fetterman’s Heart Issues Add Wild Card to Key Pennsylvania Senate Race

Just three weeks ago, a varied cross-section of Pennsylvania Democrats put its hopes on the broad shoulders of John Fetterman, confident that the commonwealth’s burly lieutenant governor could vanquish anything or anyone that a fractured Republican Party could throw at him.

But as the general election season begins, the 6-foot-8 Mr. Fetterman suddenly seems a good deal more vulnerable, equipped now with a pacemaker and a doctor’s note attesting that he can campaign and serve as Pennsylvania’s next senator, though the candidate himself admitted he “almost died.”

And what seemed like a protracted, divisive fight in the G.O.P. over the party’s nominee to take on Mr. Fetterman ended suddenly on Friday when Dr. Mehmet Oz accepted the concession of David McCormick, his narrowly beaten opponent. A three-way slugfest between a celebrity, Dr. Oz, an out-of-state hedge fund manager, Mr. McCormick, and a far-right Fox News pundit, Kathy Barnette, slipped quickly away into memory.

What was left for the fight over the Senate seat deemed most within reach for a Democratic takeover was a heart patient, Mr. Fetterman, battling a heart surgeon, Dr. Oz, and a distinct sense of unease, at least for now, among some Democrats.

“It’s going to be a brutal campaign,” said G. Terry Madonna, a longtime pollster and political writer in Pennsylvania. “If I had to put it in a couple of words, it’s ‘no holds barred.’”

Mr. Fetterman’s health struggles could be particularly resonant because so much of his appeal has stemmed from his image of vitality. Though he hails from his party’s left flank, he has garnered the affections of more moderate, working-class voters with his bald head, goateed face, Carhartt sweatshirts, baggy basketball shorts and tireless campaigning in every nook of the state.

Sarah Longwell, a Republican strategist who has conducted focus groups with Pennsylvania voters, quoted Democrats saying, “You know, he’s the physical embodiment of Pennsylvania.”

Now that common-man appeal must include the contrition of an ailing patient who ignored his doctor’s advice for years and an overt appeal to the sympathies of the voters.

“Like so many others, and so many men in particular, I avoided going to the doctor, even though I knew I didn’t feel well,” Mr. Fetterman said in a statement on Friday that broke weeks of silence since he had left the campaign trail. “As a result, I almost died. I want to encourage others to not make the same mistake.”

The statement read like a confession. He suffered a stroke last month, just days before Pennsylvania’s primary, and seemed to let his campaign systematically downplay his condition. All that ended on Friday when he admitted that he suffered from a heart condition called cardiomyopathy and had left other heart issues untreated for years.

His physician, Ramesh R. Chandra, released a scolding note saying that when Mr. Fetterman was diagnosed with atrial fibrillation and a decreased heart pump in 2017, he was prescribed medicine, lifestyle changes and follow-up appointments, but that he “did not go to any doctor for five years and did not continue taking his medications.”

The drama might enhance Mr. Fetterman’s appeal by further humanizing him, but that is not assured. Shawn W. Rosenberg, a professor of political and psychological science at the University of California, Irvine, who has been studying politics and political style since the late 1980s, said Mr. Fetterman’s imagery before the health scare had broken new ground. Where once clean-scrubbed youth sold well, Pennsylvanians have lapped up their lieutenant governor’s Everyman look.

“Do we want a political leader who is a version of the guy next door or someone who stands above us in some respects?” Professor Rosenberg asked. “Most of the literature suggests we want the latter, and Fetterman is an interesting challenge to that.”

He added: “That works to his advantage in Pennsylvania. Part of the Republican play since Trump is anti-elitism. Against Oz, he’s clearly not the elitist.”

But his health struggles also might clash with his superman image as it bolsters his opponent, a heart surgeon who has spent his extensive television career touting medical interventions, many legitimate, some questionable.

In a fight between a Paul Bunyan-like common man and a celebrity doctor, the doctor might emerge as the responsible candidate. And Dr. Oz will know how to sell it, said Samantha Majic, a political scientist at John Jay College of Criminal Justice, who studies style and celebrity in politics.

“Celebrity in the modern sense is somebody who is known, highly produced, managed and in the media, but they are also commercialized, they are using their celebrity to sell,” Professor Majic said. She added: “As campaigns become more expensive, you’ve got to have celebrity capital to parlay into financial capital. You have to stand out.”

Among Democrats and many independents in Pennsylvania, Mr. Fetterman is popular. A poll from Franklin & Marshall College just before the primary — and before his stroke — found that 67 percent of Democratic voters viewed him favorably, well above the 46 percent who felt warmly toward his primary opponent, Representative Conor Lamb.

Berwood A. Yost, the director of the Center for Opinion Research at Franklin & Marshall, said that given the Democratic nominee’s 52 years of age, his health problems “may make Fetterman even more relatable.”You get to your 50s as a working-class person, and you’ve got some scars to show for it, right?” he said. “It’s a further contrast between the two candidates. I mean, the contrast couldn’t be any more stark.”

And a comeback from a health setback is not uncommon. Senator Bernie Sanders, the Vermont independent whose progressive politics are similar to Mr. Fetterman’s, suffered a heart attack in late 2019, with the presidential primary season looming, and hardly skipped a beat.

But Mr. Fetterman will remain off the campaign trail for some time.

“Doctors have told me I need to continue to rest, eat healthy, exercise and focus on my recovery, and that’s exactly what I’m doing,” he said in his statement. He added: “It’s frustrating — all the more so because this is my own fault — but bear with me, I need a little more time. I’m not quite back to 100 percent yet, but I’m getting closer every day.”

Rebecca Katz, a strategist for Mr. Fetterman, strongly denied that the campaign had been keeping his condition hidden. Campaign officials announced he needed a pacemaker as soon as they learned it, and the campaign released Friday’s statement as soon as the doctor gave his permission, she said. Democratic officials had grown so worried that there was chatter about recruiting a new nominee, gossip that she pushed back on hard.

“All we have is the truth, and that’s what we chose to share,” she said.

If Mr. Fetterman is limping into the general election, so is Dr. Oz. Ms. Longwell said the Democrat’s overwhelming popularity with his base was the mirror opposite of the reaction to Dr. Oz, who elicits strong suspicion from some conservative Pennsylvania voters, despite the endorsement of former President Donald J. Trump. And the Fetterman campaign has already started attacking the Republican as a New Jersey interloper who is coming to Pennsylvania via Hollywood.

Given the overall political environment, Mr. Yost said the race is a true tossup, but he too wondered how Dr. Oz’s lack of connection with his new state will work in the commonwealth.

“There’s a sense of place here among long-term residents,” he said, “and Oz really isn’t from here. I wonder how that plays out.”

In a video statement, Dr. Oz vowed to start afresh after a difficult primary fight.

“I’m going to reach to every corner of this commonwealth,” he said. “I know we’ve got to heal. We’ve got to pull people together again. I want to make sure that happens again.”