Last week, Senator Mitch McConnell of Kentucky went silent.  He was addressing reporters with his cast of supporting Republican lawmakers behind him when he stopped talking in the middle of a sentence.  He stared blankly ahead with his eyes open and his mouth shut for 23 seconds before his colleagues realized something was wrong.  They led him back to his office, from which he re-emerged several minutes later. He provided no explanation for the episode dozens of people had just witnessed.

Most 81-year- old men exhibiting what appeared to be a momentary alteration of consciousness or at least a transient loss of language and mobility would have been taken to an emergency room for general medical and neurologic testing.  Senator McConnell is not “most 81 year old men.” He is one of the most important politicians in America, and a power structure has developed around him in recent decades that will not tolerate any signs of weakness. Those men and women standing behind him as he stopped midsentence in his remarks looked more concerned than mere anxiety about the health of an elderly colleague warranted.  That they took him back to the microphone he had just gone mute in front of, rather than to the nearest emergency room, spoke volumes regarding their priorities.

Benjamin Disraeli, the Prime Minister of Great Britain during much of Queen Victoria’s reign, advised his colleagues to “Never complain. Never explain.” When we do get explanations from our elected leaders, even the least cynical of us doubt the veracity or relevance of that information. Our skepticism is well-founded. When a politically disastrous event has befallen them, men and women who have spent most of their lives trying to climb another rung on the political ladder abruptly announce that they want to spend more time with their families, families who have served primarily as backdrops for photo-ops. They say they need to focus all of their time and attention on an activity in which they previously had no interest or need to concern themselves.

According to the politicians’ devoted apparatus, dementia or terminal illnesses are no reason to step aside from that cherished post. More chemotherapy, more heart surgery, more rehabilitation, they insist, are all that is needed to keep our lawmaker competent to make decisions that affect every American.

Even the 1948 Dixiecrat candidate for the Presidency, Strom Thurmond, an ardent segregationist and white supremacist, was deemed fit to serve in Congress for decades as his intellect deteriorated in full public view.  During his last years in the Senate, many described him as unarguably, mentally incompetent.  Despite running repeatedly on state and federal platforms that advocated strict racial segregation and white supremacy, he was designated President pro tempore of the Senate three times.  That designation made him third in line (after the Vice-President and Speaker of the House) to the Presidency. [Despite his opposition to mixing of the races, he impregnated the Thurmond’s African-American 15 year-old housekeeper and acknowledged that he was the father of her mixed-race child. South Carolinian voters did not detect any hypocrisy in his positions.]

Many members of Congress, the Judiciary, and even the Executive branches of the government have had obvious dementia, addictions, or terminal illnesses that necessarily interfered with their ability to function in the offices to which they were elected or appointed. Since the creation of the United States, powerful men and women in government and the judiciary have clung to their positions. Any evidence of infirmity, such as Strom Thurmond’s dementia and Mitch McConnell’s “episode,” is deemed of no consequence by those whose own political careers are tied to their ailing, elderly or otherwise impaired ally.

There will inevitably be much speculation regarding the 23 second episode affecting the Senate Minority Leader.  That his loyal colleagues will reveal the nature of his problem is unlikely. His inner circle will probably attribute the event to fatigue, distraction, or a reaction to an over the counter medication, such as an antihistamine. Those outside his inner circle but within the Washington, D.C. “club” are unlikely to offer any explanation or comment for the episode the world witnessed. The brief interval captured on videotape suggested several common bases for his immobility and language interruption, none of which is benign.

What was evident on the unedited videotape was that he did not fall, shake, or make any sounds. He did not stagger or limp as he was led back to his office. This makes a sudden drop in blood pressure or blood sugar unlikely: in either circumstance he typically would have fallen. A transient heart rhythm abnormality would usually produce a drop in blood pressure and also lead to a fall or staggering. There was no evidence of facial asymmetry or limb incoordination as he was escorted by his fellow Republicans to his office.  This makes a stroke unlikely but a possibility, nonetheless.  His rapid recovery rules out a substantial intracranial bleed or a chemical imbalance in his blood.

What we are left with as most likely diagnoses are a transient ischemic attack (TIA), seizure disorder, or an inadequately treated, but undisclosed, chronic condition, such as Parkinson disease, that can produce what are known as “off states.” With a TIA, there is a temporary interruption in blood flow to part of the brain.  This is often followed by a full-fledged stroke within a few weeks if left untreated.  A seizure disorder is a transient disturbance of the brain’s electrical activity.  It can produce the ‘akinetic mutism’ the senator exhibited and is often an initial sign of a structural brain problem, such as a tumor or a small stroke, in an elderly person. Parkinson disease and other degenerative diseases of the brain can produce episodes of immobility and mutism of the sort Mr. McConnell experienced even if they are taking medication to suppress symptoms of their disease.

Simply put, nothing good or innocuous causes what Senator McConnell exhibited. He needs medical attention, not legislative responsibilities.  His real friends will urge him to  retire. His political dependents will urge him to continue in his current role until he cannot enter the Senate chamber without being carried in.

Dr. Lechtenberg is an Easton resident who graduated from Tufts University and Tufts Medical School in Massachusetts and subsequently trained at The Mount Sinai Hospital and Columbia-Presbyterian Medical Center in Manhattan.  He worked as a neurologist at several New York Hospitals, including Kings County and The Long Island College Hospital, while maintaining a private practice, teaching at SUNY Downstate Medical School, and publishing 15 books on a variety of medical topics. He worked in drug development in the USA, as well as in England, Germany, and France.

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