Mitch McConnell stopped speaking in the middle of a sentence, stood mute, and stared directly ahead for more than twenty seconds…again. The Senate Minority Leader was again led away from the intrusive press corps that surrounded him in an obvious and ill-fated attempt to convince onlookers that they had not witnessed what they had just witnessed. For the second time in less than two months, Mitch McConnell had an inexplicable alteration of consciousness or loss of motor control. Either his mind had strayed to another dimension of space and time or his brain had lost control of his body. Once again his staff insisted he was fine and even got a physician they contacted by phone to certify the Senator’s excellent health.
Nearly sixty years ago, the States ratified the 25th amendment to the Constitution. This outlined the process for replacing a President who could no longer perform his duties by virtue of death or disability. No such formal guide was ever adopted for the removal of a disabled Senator. Senators can be tried by their colleagues and expelled from the Senate for bribery, treason, or “high crimes and misdemeanors,” but there is no explicit mechanism for forcing the retirement of an obviously impaired Senator. Mitch McConnell could theoretically continue to ‘serve’ in the Senate, even as the minority or majority leader, long after his intellectual abilities were severely impaired.
There are several likely explanations for what America witnessed as Senator McConnell stared mutely ahead of himself. The most likely is a seizure, an episode of disorganized electrical activity in the brain. This can develop after head trauma: the Senator had a “concussion” in March, 2023, when he tripped and fell. An alternative explanation is that he fell and hit his head because he had a seizure, not that he had a seizure because he fell and hit his head. Seizures are increasingly likely in the elderly, usually as a consequence of undiagnosed vascular disease. Senator McConnell is 81 years old. Seizures caused by minor head trauma or vascular disease can usually be suppressed with medication. The seizure itself does not cause brain damage.
A more worrisome but more easily diagnosed cause of seizures in an 81 year old man is a brain tumor. Presumably, the Senator has had or will have an imaging study of his head to rule out that possibility. Even if a brain tumor is responsible for his disturbance of consciousness, there is no expectation that he will resign his Senate position. Senator Edward Kennedy developed seizures caused by a malignant brain tumor in 2008 but continued to serve as one of the Senators from Massachusetts for more than a year after the diagnosis. He died in 2009 without resigning his position.
Senator McConnell may have experienced what is called an “off episode,” a phenomenon associated with some movement disorders, such as Parkinson disease. With that problem, the affected individual may be frozen in the manner the Senator was immobilized. This is less likely than a seizure disorder because the “off episode” is not typically as brief as that exhibited by McConnell and there are usually other movement abnormalities, such as tremors or gait disturbances, after the “off episode” passes.
Problems with blood flow to the brain may produce temporary disturbances of strength, sensation, or consciousness. These are called transient ischemic attacks or TIAs. Ischemia is a medical term for poor blood supply. TIAs typically last seconds or minutes and are often a sign of an impending stroke. TIAs by definition do not cause brain damage, but strokes involve permanent brain damage. There are numerous causes of TIAs, and many can be managed before a stroke occurs.
Whatever caused the episodes witnessed around the world, one must conclude that Senator McConnell has a serious health problem. He could retire from the Senate with benefits that would be the envy of most Americans. Indeed, the only thing he would lose with retirement is his power. Currently, he is one of the most powerful men in America, which makes him one of the most powerful men in the world. His staff and political allies certainly do not want him to surrender his position, since he is literally a lifeline for them. Without him in his current position, his staff would risk losing their jobs. His political allies would lose even more without the friendly relationships that require many years and many dollars to develop. Whatever it takes, short of embalming him, they will prop him up and carry him onto the Senate floor to continue doing the business they have relied on him to do for decades as the longest serving Senate party leader in history.
Paradoxically, McConnell’s episode may hurt President Biden’s chances for re-election more than they affect McConnell’s tenure as Senate minority or majority leader. Biden will be 82 if he wins the 2024 election and is inaugurated in 2025. His age already impacts his re-election odds, but with the obvious decline of octogenarians like McConnell and three other members of the Senate who are more than 80 years old and the 15 other members of the House of Representatives who are more than 80 years old, Americans will be even more wary of electing a candidate who may not be healthy enough to serve for four more years. If President Biden has a public display of infirmity of the sort McConnell exhibited, his chances for re-election will evaporate.
That the Republican nominee for the presidency will be 78 years old by the time of his potential inauguration and has long consumed a ‘hopeless-heart’ diet appear not to have registered with voters as potential problems. In fact, the former [and possibly future] President’s unapologetic consumption of and tolerance of Kentucky fried chicken and Big Mac meals supports the view of many of his supporters that he shares their disdain for science and joyously embraces “alternative facts.”
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.
