Dianne Feinstein, John Fetterman, Joe Biden, and Mitch McConnell all have one thing in common. Lots of people are calling for their retirement due to “mental disability.” Senators Feinstein and Fetterman have obvious mental problems that simply cannot be brushed away. Joe Biden’s mental “fade” isn’t quite so blatant, but when we get to Cocaine Mitch, it seems that the only exercise many pundits get is jumping to conclusions.

It’s time to take a momentary side trip. I am a Board Certified Anesthesiologist, which means that I was the cardiologist in the operating room. I did that job in private practice for thirty-two years, so I’ve had exposure to just about everything cardiac, with around three thousand open heart surgeries under my belt for good measure. I was also involved in a large number of neurosurgery cases. One of the key features of that background is that I had to know where my limits were.

So, when I dealt with Hillary Clinton’s probable Parkinson’s Disease back in 2016, I sought out expert assistance first. I built a “differential diagnosis” list before commenting. And finally, I made it painfully clear that I was not her treating physician and was working from publicly available information leading to an informed opinion, not a diagnosis.

This is the situation with the Turtle. I am not his treating physician and do not have access to his medical records. But there is public information, and my cardiologist and I discuss it on the way to the golf course each week. Put bluntly, Mitch does not appear to be in the same medical category as the others. They all have mental problems originating in the brain. He does not appear to be in mental decline.

Image: Mitch McConnell. X screen grab.

At this point, please be clear. I carry no water for the despicable Senior Senator from Kentucky. I said so five years ago in clear terms. It is my considered opinion that he should retire at the end of this term, if not sooner. (Fortunately, if he is forced to retire, Kentucky law holds that the new senator must come from the same party as the retiring senator.) This discussion is about medical issues.

The public record of McConnell’s brain function problems starts on March 9, with a fall at the Waldorf Astoria Hotel in Washington, D.C. He hit his head, leading to hospitalization and a diagnosis of a “concussion.” Then a few weeks ago, while answering questions from the press, he “froze” for about twenty seconds and was led away. Not long after, he reappeared, none the worse for the wear. And on August 30, it happened again, this time for about thirty seconds. And it appears that he has had other falls that were not previously reported.

When Mitch fell, his representative said,

Leader McConnell tripped at a dinner event Wednesday evening and has been admitted to the hospital and is being treated for a concussion. He is expected to remain in the hospital for a few days of observation and treatment.

McConnell “tripped.” In other words, he was walking and fell. Hold that thought. On both other occasions, he was standing at a lectern, steadying himself by holding its sides. Curiously his aides don’t seem surprised by these events, suggesting that they also happen behind closed doors. He doesn’t seem to lose consciousness, since he answers his aides when they ask if he’s OK. This leaves us with a short list of places to look.

First, McConnell’s speech has been a bit “mumbly” for some time. That suggests that he may have had some sort of a small stroke near the speech area at some time. People who have strokes may have repeat strokes. They may also have Transient Ischemic Attacks (TIAs) where blood flow is significantly reduced. These can look like what we see. And they would suggest that more actual strokes may be likely.

Another related possibility is that these events represent Complex Partial Seizures. His eyes deviate to the right during the event and return to center when he recovers. This sort of seizure can have multiple causes and would require an EEG during an event for firm diagnosis.

A third possibility is that these events are cardiac in origin. My cardiologist friend says that they look like Stokes-Adams or Sick Sinus Syndrome attacks. Basically, these are short periods of extremely slow or even stopped heart rhythm. This very slow heart rate reduces blood flow to the brain causing a mental “fade-out” that then recovers.

Three observations are important here. All three of these possibilities are not involved with mental capacity, unlike Feinstein, Fetterman, and Biden. All three of them can cause the freezes, light headedness, and even falls that have been reported. And finally, all three of them are intermittent, making them hard to catch and identify with high confidence. The problem is very much like that squeak you hear in your car. When you take it to the mechanic, it’s not there, but it comes back when you go to the grocery store.

Mitch’s health problems point to a truly big problem. We have an entitled class that thinks that particular seats in our federal government belong to them personally. No, they don’t have the prohibited “Count,” “Baron,” or “Prince” title of nobility, but they might as well because they rig things to prevent meaningful opposition during election season. They will never agree to medical disqualification rules.

Perhaps it’s time for a Convention of States to meet and propose a term limit amendment to the Constitution. It’s not a perfect solution, but if it’s good enough for the President, it ought to be good enough for CongressCritters.

UPDATE: This post has been corrected. I previously misstated Kentucky law when it comes to the governor's power to fill a senatorial vacancy in Congress.

Ted Noel MD is a retired Anesthesiologist/Intensivist who podcasts and posts on social media as DoctorTed and @vidzette. His Doctor Ted’s Prescription podcasts are available on many podcast channels.