Control of the U.S. Senate could depend on whether Pennsylvanians elect Democrat John Fetterman or Republican Dr. Mehmet Oz on Tuesday, capping a bare-knuckled and extraordinary campaign for an open seat.

Fetterman, Pennsylvania’s towering and plainspoken lieutenant governor, spent much of the campaign recovering from a stroke in May, while fending off attacks by Oz that questioned whether he was honest about its effects and fit to serve.

With two weeks to go in the race, Fetterman turned in a rocky debate performance, struggling to complete sentences, jumbling words throughout the hourlong televised event and fueling concern inside his party that it damaged his chances.

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To underscore the importance of the race, President Joe Biden campaigned in Pennsylvania for Fetterman three times in the final three weeks, while former President Donald Trump came in to hold a rally for Oz, his endorsed candidate.

Oz, 62, carried his own baggage into the election in the presidential battleground state. The smooth-talking and wealthy heart surgeon-turned-TV celebrity just moved from his longtime home in neighboring New Jersey — a mansion overlooking the Hudson River, just across from Manhattan — and barely won a bruising primary in which opponents cast him as an out-of-touch Hollywood liberal.

Polls show a close race, with the economy weighing heavily on voters.

Roughly 8 in 10 Pennsylvania voters say things in the country are moving in the wrong direction, according to AP VoteCast, an expansive survey of more than 3,100 voters in the state.

About half the state’s voters say the economy and jobs are the most important issue facing the country, according to the survey. And about 8 in 10 voters rate the nation’s economy as either not so good or poor.

The Supreme Court’s decision to overturn Roe v. Wade also played a role in most voters’ decisions, with about 8 in 10 calling it a factor in how they cast their ballots. Only about a quarter called it the single most important factor in their vote.

Most voters say they are confident ballots will be counted accurately, according to the survey, though nearly 3 in 10 said they were either not too confident or not at all confident.

With his "every county, every vote" slogan, the tattooed and hoodie-wearing Fetterman, 53, sought to bring the Democratic Party back to rural areas. Along the way, he vowed to be the Democrats’ "51st vote" to pass foundational legislation to protect rights to abortion, same-sex marriage, unions and voting, as well as to raise the minimum wage.

Fetterman has characterized a vote for Oz as a vote to outlaw abortion — ridiculing Oz’s comment that he wants "women, doctors, local political leaders" to decide the fate of abortion — and painted Oz as a soulless TV salesman who hawked useless health supplements for money and will say or do anything to get elected.

He also wielded a wicked social media campaign that brought in a torrent of small-dollar donations and mercilessly trolled Oz for his carpetbaggery and ultra-wealthy lifestyle, plowing new ground in how campaigns might use the medium.

Pennsylvania’s seat is coming open because second-term Republican Sen. Pat Toomey decided against seeking a third term. Polls close at 8 p.m., although a judge in Luzerne County ordered all polling places to stay open until 10 p.m. after some ran low on supplies.

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Oz would be the first Muslim to serve in the U.S. Senate.

Oz, a political novice, left his lucrative daytime TV career for politics in a new state and had the help of national political headwinds against Democrats, such as rising inflation. Still, he struggled to persuade conservatives that he is one of them, while campaigning to win suburban swing voters and peel off Black and Latino voters, who lean heavily Democratic.

He relentlessly attacked Fetterman over flip-flopping on natural gas drilling and progressive stances on things like criminal justice reform. Fetterman, as lieutenant governor, had set out to free the over-incarcerated, rehabilitated or innocent. But Oz and Republicans often cast it as freeing dangerous criminals to roam the streets, distorting Fetterman’s positions in the process.

Oz also challenged Fetterman over whether he had been honest about the effects of the stroke and pressed Fetterman to release his medical records. Fetterman refused, and also refused to let his doctors answer questions from reporters.

The stroke left Fetterman occasionally stumbling over words and unable to quickly process spoken conversation into meaning, a common effect of a stroke called auditory processing disorder. Fetterman has insisted he will recover fully, but he also required closed-captioning during media interviews and the lone debate between the men.

He tried to turn his recovery into a strength, accusing Oz of trying to capitalize on his disability and saying it had made him more empathetic toward people with medical problems.

The election was the most expensive for a U.S. Senate seat in this mid-term election cycle, surpassing $300 million. Money from national groups poured in, and Oz spent more than $25 million of his own fortune on the race.