John Fetterman, the lieutenant governor of Pennsylvania, won perhaps the most remarkable victory of this year’s midterm elections with his triumph over Dr Mehmet Oz.The burly former mayor of Braddock overcame the usual bruising midterm fundamentals, which punish the party in the White House, but also a near-death experience, suffering a stroke days before he won his primary race.That might have spelled the end for the campaign, and few would have blamed him if he had dropped out. But after a short break, he was back on the road. He was open about the difficulties he faced with his recovery – the impact on his speech and auditory processing. He took to the debate stage to face off against a polished television doctor even though he knew he would lose.His campaign was different from the start.Fetterman’s rise seemed both unlikely and inevitable. Unlikely because he was an unashamed progressive running in a swing state during an election year that was expected to punish Democrats. Inevitable because he had built what many considered to be a movement campaign, powered by vibes and memes.He seemed like an answer to the Democratic Party’s biggest weakness – after years of declining support from white working class voters, who viewed it as out of touch and elite, he arrived on the scene in his shorts and a hoodie. His backdrop was the steel town of Braddock, the very kind of place that had propelled Donald Trump to the presidency in 2016. He was Pennsylvania Man.He took an unusual route to the top. Winning statewide office is supposed to precede glowing magazine profiles in the liberal press, but Fetterman was just a mayor when he started to adorn the covers. They flocked to Braddock to hear of his efforts to rebuild a forgotten town. In telling the story of Braddock, he was able to tell the story of many towns like it. He was talking about those towns that the Democrat Party left behind.A key part of his strategy was searching for votes in ‘ruby red’ parts of Pennsylvania – places where Democrats would routinely win only 10 per cent of the vote. Fetterman’s pitch was that he could win by lowering those margins.As Pennsylvania’s lieutenant governor, Fetterman visited all of the state’s 67 counties as part of a listening tour about marijuana legalisation. Since announcing his run for Senate, he has campaigned on the slogan ‘Every County, Every Vote’ – making a point to reach voters in places where history suggests a Democrat wouldn’t stand a chance of winning.His strategy paid off in the primary: Fetterman beat his opponent in all 67 counties. And it paid off on Tuesday night. In Republican-dominated counties across the state, Fetterman chipped away at the GOP’s margins. At one point, Dr Oz was only outperforming Donald Trump’s margins in one country – on the border with New Jersey.Fetterman had already moved to the former steel town of Braddock, just outside of Pittsburgh, before Trump came along. During his 13 years as mayor, he tried to revive the town’s fortunes by launching community projects and repurposing old buildings. He was urging national politicians to do more to help the left-behind towns across America’s former industrial heartlands.Fetterman, who grew up in a reasonably wealthy family in York, Pennsylvania, fell in love with the town’s ‘malignant beauty,’ as he called it. It was the work he did here in Braddock during his tenure as mayor that propelled him to the national spotlight. A tattooed, 6ft8 Harvard graduate trying to resurrect a town through innovation, art, blood, sweat and tears, drew journalists by the dozen. For many, he embodied hope in a place that was in short supply.That national spotlight provided Fetterman a platform that led to a run for office as lieutenant governor, and later the senate.Fetterman easily won his primary campaign, and despite his stroke, he took an early lead in the polls against Dr Oz. His campaign was successful in defining Dr Oz as a carpet bagger, an out-of-towner (Dr Oz lived in New Jersey before moving to Pennsylvania to run for Senate).Fetterman’s campaign also dominated the social media war, mocking Dr Oz for his wealth, his history of selling diet pills and so much more.But as the lingering impact of the stroke on his health became clear. Many Democrats wondered if he could stay the course. Those concerns seemed to be justified when he took part in the one and only debate with Dr Oz in Harrisburg, Pennsylvania.All political campaigns aim to manage expectations before a debate – it’s a tried and tested method of reframing what a victory looks like. But for Fetterman’s team, there was an important reason to go the extra mile.Since suffering a stroke in May, Mr Fetterman has had trouble with auditory processing – a common issue with recovering stroke victims. It means that he sometimes has trouble hearing sentences and will stumble over some words, especially when several people are speaking. In short, it is hard to imagine a more inhospitable environment for someone in his position than a debate stage, with the inevitable crosstalk, interruptions and fast-paced questions.To help him process the questions during the debate, moderators agreed to provide real-time captions that transcribed everything the moderators and Dr Oz said. The words came down on two large television screens that hung over the moderators, who explained at the outset how they would work.In his opening statement, Mr Fetterman addressed what he called the ‘elephant in the room,’ and compared his own health struggles with the fortunes of Pennsylvanians.Emotional Fetterman lost for words after winning Pennsylvania Senate race’I had a stroke. He’s never let me forget that,’ he said, referring to attacks by Dr Oz’s campaign on his health. ‘And I might miss some words during this debate, mush two words together. But it knocked me down and then I’m going to keep coming back up. And this campaign is all about to me is about fighting for everyone in Pennsylvania that ever got knocked down, that needs to get back up, and fighting for all forgotten communities all across Pennsylvania.’It was clear from the outset that the debate would be difficult for Mr Fetterman, but the question remained: in the midst of his recovery, could Mr Fetterman overcome his health difficulties to deliver his message, and explain his policies to the people of Pennsylvania?As his campaign forewarned, Mr Fetterman stumbled on his words frequently. He struggled to answer questions that he has answered many times before, on topics that he clearly knows well. His most difficult moment came when he was challenged on his previous opposition to fracking, something he now supports, and was unable to provide an explanation.But if the point of the debate was to inform viewers of each candidate’s policies, and not about performance, then Mr Fetterman turned up at the key moments. On abortion, he drew a distinct line between himself and Dr Oz.’I want to look into the face of every woman in Pennsylvania. You know if you believe that the choice of your reproductive freedom belongs with Dr Oz, then you don’t have a choice. But if you believe that the choice for abortion belongs with you and your doctor, that’s what I fight for. Roe v Wade for me should be the law,’ he said.Mr Fetterman turned his weakness into a story that struck a chord with voters.”I’m going to fight for everyone in Pennsylvania that ever got knocked down and had to get back up,’ he said.Polls taken after the debate all skewed towards Dr Oz, but Fetterman, it is now apparent, had done enough to get his message across.