Memories of retiring from medicine flooded me while watching the recent presidential debate, a distressing experience for many staunch Democrats, including me.

Joe Biden’s struggles to speak clearly and move fluidly brought back difficult memories of how my illness forced the end of a satisfying medical career. Faced with the toughest choice imaginable, I decided for the collective good. Now we as a country find ourselves in a similar dilemma, with much higher stakes.

The debate took me back to a cold March day in 2016. At the time, I was a medical oncologist thriving in my career, but on that day, I was the patient, waiting nervously in my rehab doctor’s office. Over the previous nine months, I tried to recover from a cervical fusion, a surgery that unites vertebrae in the spine, performed for “presumed” disc herniation doctors believed caused my neck pain.

The surgery made it hard to hold my head up for an entire day or sit at a desk for an hour. As I became more compromised, I consulted with many physicians over whether I could continue my passion: caring for patients facing life-threatening cancer diagnoses and conducting research to improve their quality of life.

When my doctor came into the room that day, his expression said it all. “Jen,” he said, voice cracking, “I’m so sorry.” In his view, the accommodations I’d adopted over those months–longer appointment times, new dictation system, rest between patients–hadn’t been enough to allow me to give my best to patients. How could my career as an oncologist be over?

Though crushed, I knew that leaving medical practice was right. After all, I’d taken the Hippocratic Oath: “First, do no harm.” If I had a bad day or pushed too hard, I might make a catastrophic mistake, such as incorrectly dosing chemotherapy or missing a life-threatening complication. My priority was patient well-being which I put above my ego and professional identity. I retired soon after.

That brings us to President Biden. As many have written, his debate performance raised critical concerns beyond age, an off-night, or symptoms of a “cold.” Too many times, he seemed confused and had trouble finding his way to the end of sentences or even making sense, such as his comment about Medicare. Indeed, his vacant facial expression, shuffling gait, and stiff arms suggest a possible neurodegenerative disorder.

The lack of facial expression, specifically known as “masked facies” or hypomimia, is a hallmark of Parkinson’s Disease. In his recent New Yorker article “The Writing on Joe Biden’s Face,” Vinson Cunningham describes how observers watching the debate in a bar noted Biden’s “masked face.” Reddit is rife with posts questioning whether the President has dementia or Parkinson’s Disease. Family members of frail patients state that Biden’s mannerisms remind them of their loved ones. Perhaps, we are witnessing the toll of a mind-body system worn down by age, no longer capable of swift reactions.

Many physicians, including neurologists and geriatric specialists I know, raise the same concerns in private conversations and on doctor-only Facebook groups. But they hesitate to voice their suspicions publicly. But given my history, I have to say something publicly.

The stakes are rising daily. His February 2024  health summary from his personal physician,  Dr. O’Connor, does not address concerns regarding Biden’s mental acuity or absent facial expressions, despite mentioning other more trivial diagnoses and treatments (basal cell carcinoma and a root canal). That 2024 memorandum states that Dr. O’Connor assembled a team of specialists, including spine and “movement disorder neurologists,” in 2021 who concluded that Biden’s stiff movements are due to arthritis.

In other words, according to Dr. O’Connor’s medical notes, he has not consulted a neurologist or cognitive consultation team over the past three years. Perhaps equally perplexing is that President Biden, in his interview with ABC News, did not remember or refer to the prior neurologic consultations.

In fact, the majority of the 2024 summary addressing Biden’s stiff gait is verbatim from the 2023 health summary. Sadly, it appears even the President’s doctor is subject to the habit of “cut-and-paste” that plagues the broader electronic medical record, leaving Biden’s current condition largely unknown. Dr. O’Connor does not question Biden’s diagnosis of osteoarthritis, which is present in nearly 100% of older individuals who undergo X-rays. Instead, Dr. O’Connor sticks to this same diagnosis each year and orders no further testing.

My case included ambiguity but not of the intentional variety. After retiring in 2016, my condition did not improve. Over the next six years, I relentlessly sought second opinions and underwent multiple treatments that ultimately proved unhelpful, including two surgeries. Eventually, I had an accurate diagnosis: Ehlers-Danlos Syndrome, which makes the ligaments in my body overly stretchy.

An early diagnosis would have put me on the right treatment path, perhaps enabling me to continue my medical career. But my team relied largely on imaging rather than more obvious physical symptoms such as my hypermobile body. While it’s too late for me, we can do more to understand and get ahead of what President Biden is now consistently showing us.

Physicians and politicians, though both dedicated to public service, operate within vastly different cultures. Physicians regularly participate in “morbidity and mortality” and quality improvement conferences, openly discussing and scrutinizing their mistakes. This rigorous peer-review process fosters accountability as colleagues confront one another about decisions that have harmed patients. Transparency ensures that health or personality problems among doctors are promptly addressed, cultivating a culture of continuous improvement.

In stark contrast, President Biden had received unwavering support from allies like Governor Newsom, without many Democratic leaders immediately post-debate calling for cognitive assessments until this past week. Unlike the medical field, there is no equivalent forum in politics where leaders systematically review their performance and openly confront their mistakes. Biden did not even watch his debate performance.

Our daily interactions with patients ground doctors in the human condition, fostering humility. On the other hand, politicians like Biden often develop outsized egos to navigate and survive the rigors of political campaigns (only the Lord Almighty will tell Biden to drop out). In medicine, effective practice hinges on each team member’s competence, ensuring a well-oiled machine. However, the Democratic party so far appears flawed, appointing and supporting an aging leader.

Since retirement, my grief over leaving a noble profession has waned. But sometimes, when I’m alone, tending to myself instead of engaging with patients and colleagues, my loss can feel overwhelming, and I wonder what might have been.

I also understand why President Biden’s family and administration encourage him to soldier on. My family struggles to accept my limits, often encouraging me to persist in activities that I simply cannot do on a given day, even a simple beach walk. Some observers speculate about “coverups” by those close to the President, but more likely, his confidants are struggling to come to terms with the decline of a loved and respected colleague or family member. We should empathize with the President because this denial, even from well-meaning people, can be isolating and ultimately damaging.

I am proud of how I adapted to a life changed irrevocably by illness. While I no longer wear the badge of conventional success, I feel deep pride in living with grace, dignity, and acceptance of my limitations. I look back with satisfaction, having helped many patients and their families, even as I lament that I can no longer do this as a doctor.

President Biden, like me and millions of other Americans whose lives are compromised by illness or age-related decline, could eventually find peace in accepting his condition and reflecting on a rich career of public service rather than putting himself in a position to have to make critical future decisions–about military conflict or a financial crisis–for which he may not be capable. It’s time we all recognize this reality, painful as it is, and advocate for the man in charge of the world’s most influential nation to act in everyone’s best interests, including his own.

Jennifer Obel is a hematology-oncology physician.

Image credit: Jonah Elkowitz/Shutterstock.com