Bernie Had a Heart Attack. We Need To Talk About That.

What’s worse: Bernie Sanders’ heart attack, or the fact he’s not being candid about it?

If there were a 25th Amendment for presidential candidates—that is, a mechanism to remove a physically unfit candidate from the campaign the way there is a constitutional mechanism to unseat a president who can’t “discharge the powers and duties of his office”—we would be talking right now about subtracting Bernie Sanders from the campaign trail until he proves himself physically fit to assume the powers of chief executive of the United States.

The 78-year-old senator from Vermont was hospitalized last week after complaining about chest pains during an October 1 campaign event in Las Vegas. Doctors inserted two stents in one of Sanders’ blocked arteries, but he, his campaign and his wife and close adviser Jane Sanders wouldn’t say whether he had experienced a myocardial infarction—the death of heart-muscle cells that we laymen call a heart attack. After three days of stonewalling from his campaign, Sanders publicly disclosed the fact he’d had a heart attack—something an urgent-care clinic diagnosed before he even entered the hospital.

Thanks to the miracles of modern medicine, a heart attack shouldn’t automatically blackball anybody from seeking or serving as president, as New York Times medical reporter Lawrence K. Altman M.D. writes. Both Dwight D. Eisenhower and Lyndon B. Johnson occupied the White House after their heart attacks, and Dick Cheney’s four heart attacks (1978, 1984, 1988, 2000) didn’t block him from serving as George W. Bush’s vice president.

But neither is a heart attack a trivial medical condition, like a hangnail or a sprained ankle. Depending on its severity, recuperation can take weeks or months of rest. It requires lifestyle changes including reductions of stress and new dietary habits—neither of which comport well with campaign life. Patients who have had heart attacks can be plagued with depression, fear and anger, the American Heart Association reports.

Sanders’ heart attack might have been of the trifling variety—if there is such a thing—but we don’t know that. And he isn’t helping us calculate whether his health is sufficiently robust to pursue the presidency.

It’s been almost a week since Sanders was discharged from the hospital, and as the Washington Post reported on Thursday, his “campaign has yet to say how severe a heart attack Sanders suffered or what, if any, lifestyle changes his physicians have recommended.” Facing calls to disclose his health records, Sanders said they would be released at “the appropriate time,” but he won’t say when that will be.

Sanders himself seems unsure about what all of this will mean for his run at the White House. “I think we’re going to change the nature of the campaign a bit,” Sanders told reporters on Tuesday, promising to reduce his standard pace of holding three or four rallies a day. The next day, he nullified that pledge. Blaming the press for the confusion, he told NBC News, “I misspoke the other day. I said a word I should not have said and the media drives me a little bit nuts to make a big deal about it.” He went on to say he would be returning to a “very vigorous campaign.”

As for his lack of transparency about his heart event, “That’s nonsense,” Sanders told NBC News. He said he wasn’t about to run to the New York Times and decant his medical condition every 15 minutes—even though nobody was asking for that sort of granularity. “I think we acted absolutely appropriately,” he said.

But feel free to question Sanders’ capacity to judge the status of his own health—if only because he does. “I must confess, I was dumb,” Sanders said on Tuesday. “I, in the last month or two, just was more fatigued than I usually have been. And I should have listened to those symptoms.”

Now that Sanders is listening to his symptoms, he should let us eavesdrop, too, or at least get a full readout of his health from his doctors so his supporters can glean a stronger sense of whether he’ll survive his potential term in office or whether his health will trigger 25th Amendment action should heart disease strike him again.

Sanders isn’t the only elderly presidential candidate who needs to answer the public’s questions about his health. Joe Biden, who will be 78 on the next Inauguration Day, has suffered two brain aneurysms and is given to rambling when answering questions or giving speeches. Donald Trump, who will be 74 on Inauguration Day, has been opaque about his health, as the Washington Post editorial board complained in 2018.

But for the time being, Sanders remains the leading candidate for increased medical scrutiny. He’s old and getting older, and we all know where that goes. He’s a sick man. But we don’t know how sick and he refuses to tell.

Perhaps the most damning thing about Sanders’ behavior over the past week is that it gives us a preview of how he might behave should illness strike him after he takes the presidential oath. Would he and his people deflect questions, postpone disclosure, and then blame the press for making a big deal about his health?

I’d like to say Bernie Sanders is better than that. I will, too, but first he must give me a good reason to do so.

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Eisenhower’s White House tried to cover up his first-term heart attack, with his assistant press secretary telling reporters the president had suffered “a digestive upset during the night.” (Hat tip to John Dickerson’s book “Whistlestop: My Favorite Stories from Presidential Campaign History.”) John Kennedy kept his Addison’s disease secret. Send your medical history via email to Shafer.Politico@gmail.com. My email alerts suffered renal failure. My Twitter feed is shot through with cancer. My RSS feed is dead and awaits resurrection by POLITICO’s IT priesthood.

Article originally published on POLITICO Magazine