HARRISBURG, Pa. — More than five months after experiencing a stroke, Pennsylvania Democrat John Fetterman struggled at times to explain his positions and often spoke haltingly throughout a highly anticipated debate Tuesday against Republican Dr. Mehmet Oz as they vie for a critical Senate seat.

In the opening minutes of the debate, Fetterman addressed what he called the “elephant in the room.”

Democratic Senate candidate, Pennsylvania Lt. Gov. John Fetterman, left, and Republican Senate candidate Dr. Mehmet Oz in 2022 photos. Associated Press photo

“I had a stroke. He’s never let me forget that” Fetterman, the lieutenant governor, said of Oz, who has persistently questioned his ability to serve in the Senate. “And I might miss some words during this debate, mush two words together, but it knocked me down and I’m going to keep coming back up.”

When pressed to release his medical records later in the debate, he refused to commit.

Oz, a celebrity heart surgeon, ignored his opponent’s health challenges throughout the debate, instead seizing on Fetterman’s policies on immigration, crime and his support for President Joe Biden. At one point, Oz said Fetterman is “trying to get as many murderers out of jail as possible.”

“His extreme positions have made him untenable,” he charged.

The forum had many of the trappings of a traditional debate, complete with heated exchanges and interruptions. But the impact of the stroke was apparent as Fetterman used closed-captioning posted above the moderator to help him process the words he heard, leading to occasional awkward pauses.

Oz cast himself as a moderate Republican looking to unite a divided state, even as he committed to supporting former President Donald Trump should he run for president against in 2024.

“I’m a surgeon, I’m not a politician,” Oz said. “We take big problems, we focus on them, and we fix them. We do it by uniting, by coming together, not dividing.”

Fetterman also committed to supporting Biden should he run again in 2024.

The Democratic president campaigned with Fetterman in Pittsburgh during the Labor Day parade and just last week headlined a fundraiser for Fetterman in Philadelphia. There, Biden said the “rest of the world is looking” and suggested a Fetterman loss would imperil his agenda.

While backing Biden, Fetterman also said, “he needs to do more about supporting and fighting about inflation.”

Abortion was a major dividing line during the debate.

Oz insists he supports three exceptions – for rape, incest and to protect the life of the mother. When pressed Tuesday night, he suggested he opposes South Carolina Sen. Lindsey Graham’s bill to impose a nationwide ban on abortion after 15 weeks because it would allow the federal government to dictate the law to states.

“I’m not going to support federal rules that block the ability of states to do what they wish to do,” Oz said.

Fetterman delivered a blunt message to women: “If you believe that the choice for abortion belongs with you and your doctor, that’s what I fight for.”

The biggest question coming out of the debate was whether it would have a lasting impact with two weeks before the election and more than 600,000 ballots already cast. Rather than watch the full hour, many Pennsylvanians may only see clips of the event on social media. And both parties are preparing to flood the airwaves with television advertising in the final stretch.

Independent experts consulted by The Associated Press said Fetterman appears to be recovering remarkably well. Stroke rehabilitation specialist Dr. Sonia Sheth, who watched the debate, called Fetterman an inspiration to stroke survivors.

“In my opinion, he did very well,” said Sheth, of Northwestern Medicine Marianjoy Rehabilitation Hospital in suburban Chicago. “He had his stroke less than one year ago and will continue to recover over the next year. He had some errors in his responses, but overall he was able to formulate fluent, thoughtful answers.”

Problems with auditory processing do not mean someone also has cognitive problems, the experts agreed. The brain’s language network is different from regions involved in decision making and critical thinking.

Even before the debate, Democrats in Washington were concerned about Fetterman’s campaign given the stakes.

There is no better pickup opportunity for Democrats in the U.S. than the race to replace retiring Republican Sen. Pat Toomey in a state Biden narrowly carried in 2020.

For much of the year, it looked as if Fetterman was the clear favorite, especially as Republicans waged a nasty nomination battle that left the GOP divided and bitter. But as Election Day nears, the race has tightened. And now, just two weeks before the final votes are cast, even the White House is privately concerned that Fetterman’s candidacy is at risk.

Fetterman’s speech challenges were apparent throughout the night. He often struggled to complete sentences.

When pressed to explain his shifting position on fracking, a critical issue in a state where thousands or jobs are tied to natural gas production, his answer was particularly awkward.

“I do support fracking. And I don’t, I don’t. I support fracking, and I stand and I do support fracking,” Fetterman said.

At another point, the moderator seemed to cut off Fetterman as he struggled to finish an answer defending Biden’s student loan debt forgiveness program. He also stumbled before finishing a key attack line: “We need to make sure that Dr. Oz and Republicans believe in cutting Medicare and Social Security …”

The Pennsylvania Senate hopefuls faced each other inside a Harrisburg television studio. No audience was allowed, and the debate host, Nexstar Media, declined to allow an AP photographer access to the event.

Fetterman is a star in progressive politics nationwide, having developed a loyal following thanks in part to his blunt working-class appeal, extraordinary height, tattoos and unapologetic progressive policies. On Tuesday, the 6-foot-9-inch Democrat swapped his trademark hoodie and shorts for a dark suit and tie.

But Fetterman’s health has emerged as a central issue over the election’s final weeks, even as candidates elsewhere clash over issues like abortion, crime and inflation.

Oz had pushed for more than a half-dozen debates, suggesting Fetterman’s unwillingness to agree to more than one was because the stroke had debilitated him. Fetterman insisted that one debate is typical – although two is more customary – and that Oz’s focus on debates was a cynical ploy to lie about his health.

Democrats noted that the televised debate setting likely would have favored Oz even without questions about the stroke. Oz is a longtime television personality who hosted “The Dr. Oz Show” weekdays for 13 seasons after getting his start as a regular guest on Oprah Winfrey’s show in 2004. Fetterman, by contrast, is a less practiced public speaker who is introverted by nature.

Many Republicans were thrilled by the debate’s outcome, although most – including Oz – tried to avoid piling onto concerns about Fetterman’s health.

Donald Trump Jr. was less cautious.

“If Fetterman is some sort of leftist decoy to make Biden actually sound somewhat intelligent and articulate he’s doing a great job,” the former president’s son tweeted.

Peoples reported from New York. AP Medical Writer Carla K. Johnson contributed from Washington state.