Sen. Tim Johnson has come through emergency brain surgery, a coma and a grueling recovery.
Now, Johnson, a 61-year-old Democrat who battled back from a December 2006 brain hemorrhage, is running for re-election in a GOP-dominated state where President Bush won 60% of the vote in 2000 and 2004.
It may turn out to be the easiest thing he's done in two years.
Johnson, running against Republican state lawmaker Joel Dykstra, was comfortably ahead 60% to 35% in a July Rasmussen Reports poll, the most recent statewide poll on this year's race.
Johnson's popularity isn't likely to provide much help for Democratic presidential candidate Barack Obama against Republican John McCain in November.
An American Research Group poll conducted Sept. 19-21 showed McCain leading Obama 55% to 39%.
"The last time we voted for a Democrat (for president) was during the '64 race between Lyndon Johnson and Barry Goldwater," says Brent Lerseth, a government professor at Augustana College in Sioux Falls. "We didn't even vote for (George) McGovern in '72, even though he's from South Dakota," Lerseth says.
The Obama campaign, though far behind, opened an office in downtown Sioux Falls in September. The office was set up for Obama, but "we think the interest in Obama and excitement for this campaign will help other Democrats down the ticket," said Matt McGovern, state director for the Obama campaign and grandson of 1972 Democratic presidential nominee McGovern.
The McCain campaign doesn't have an office in South Dakota. They have one in St. Paul, four hours northeast of Sioux Falls. Despite McCain's lead, "we're not taking anything for granted," says McCain spokesman Tom Steward.
Even though South Dakotans have a long history of helping Republicans win the White House, Johnson has prevailed since 1996, when he defeated three-term Republican Sen. Larry Pressler.
In 2002, he defeated Republican challenger John Thune. Two years later, Thune reached the Senate by beating Democratic incumbent Tom Daschle.
"Personalities matter a lot in a place like South Dakota," and Johnson was a likable candidate, says Kenneth Blanchard, a political science professor at Northern State University in Aberdeen.
"The United States Senate is much less subject to party pressure on the part of the voters in large part because we sort of expect our senators to be the defenders of the state in the federal legislature, especially when it comes to bringing home federal money," Blanchard says.
The possibility Johnson might have had to step down were big issues for Democrats in 2006. The party's newly regained control of Congress was at stake.
If Johnson hadn't been able to continue as a senator, South Dakota Gov. Mike Rounds could have appointed a fellow Republican to the Senate, and Republican Vice President Cheney would have cast deciding votes in the Senate, Lerseth says.
Since returning to the Senate on Sept. 5, 2007, Johnson has used a motorized scooter to get from his office to the Capitol. His speech is still slurred, and he sometimes needs a few seconds to find answers to questions.
In a meeting with a group of South Dakota educators visiting his Senate office last month, Johnson said, "My speech is not perfect, as you know." In his low-key style, he told them he would work hard for educational programs: "I'll do the best I can."
In August, Johnson announced he would not participate in traditional political debates because of lingering speech problems. Dykstra has sought to keep that decision in the minds of voters.
"The Dykstra campaign wants to keep it very much front and center because it raises questions about the senator's verbal ability," says Elizabeth T. Smith, associate professor of political science at the University of South Dakota. "If you look on Joel Dykstra's website, they have T-shirts now that say 'Dykstra ??? No Debate About It.' "
Robert Grossmann, 71, a pastor in Johnson's hometown of Vermillion, says he expects Johnson to get a large sympathy vote.
"I have sympathy for the man myself; I hope things get better," Grossmann says. "I just really think he should have resigned or not run."
Lorri May, 46, of Madison heard Johnson speak at the state Democratic convention, where she was a delegate. "I don't think it has affected his ability to serve," she says.
Dykstra says he has tried to focus on issues, not Johnson's health. Still, Dykstra says, voters constantly ask him about it.
Michael Yochelson, medical director for brain injury programs at National Rehabilitation Hospital in Washington, says the senator has "made great strides."
"I hoped all along I would stay in politics and do my state some good," Johnson says. "But I didn't know if I could. But as time went on, I grew ever more confident that I could run for office again."
Martin reports for the Argus Leader in Sioux Falls, S.D.