Politics can be an ugly business.
But even by American standards, the battle for one of Pennsylvania's highly sought-after seats in the US Senate has been particularly brutal.
In one corner is Mehmet Oz, better known as Dr Oz, a Trump-backed Republican who shot to fame on the Oprah Winfrey Show before hosting his own long-running TV program.
Critics paint him as an out-of-touch celebrity with weak ties to Pennsylvania and a questionable business record.
Winfrey, the woman considered to have launched his showbiz career, has publicly endorsed his opponent.
And in a scandal giving new meaning to the term "dog fight", he has been accused of — and vigorously denied — links to the deaths of hundreds of puppies in a research lab.
Oz's polished presentation stands in contrast to his opponent John Fetterman, a 2.07-metre former mayor with a bald head and a preference for wearing hoodies on the campaign trail.
The progressive Democrat, who currently serves as Pennsylvania's lieutenant governor, is criticised by his detractors as being a left-wing radical who is soft on crime.
They have also questioned his fitness for office as he recovers from a stroke experienced less than six months ago.
With control of the US Senate potentially on the line, the pressure on both sides is intense.
And as last-minute dashes to Pennsylvania by both Joe Biden and Donald Trump demonstrate, it's a high-stakes test for both the current president and his predecessor.
Why all eyes are on Pennsylvania
Pennsylvania's place in the spotlight is not only due to the personalities in play.
The swing state could also decide which party holds power in the upper house of Congress.
The Senate is currently split 50/50, with Democrats holding the narrowest of majorities through the tie-breaking vote of Vice-President Kamala Harris.
Pennsylvania was won by Trump in 2016 before being picked up by Biden in 2020.
With the retirement of sitting Republican senator Pat Toomey, Democrats sense one of their best chances to flip a seat and keep control of the chamber.
But it won't be easy. While polls suggest Fetterman has maintained a slight edge over his opponent, the race has tightened in recent weeks.
FiveThirtyEight, which collates polling data, now has it pegged as a "toss-up".
When a swarm of media crews descended on a TV station in suburban Harrisburg, the state capital, for the only debate between the two candidates, supporters from both sides turned out to have their say.
"I think he's an opportunist. 'Carpetbagger' comes to mind," Fetterman voter John Abbott said, referencing the decades Oz spent living in a New Jersey mansion before buying property near Philadelphia last year.
"You know, coming to Pennsylvania, wanting to run for office, just because he could."
Metres away, Laurie Johnson wore a flashing cowboy hat as she proudly displayed a Dr Oz sign.
"I think that he's a self-proclaimed socialist," she said of Fetterman.
"And the ideologies that he [subscribes] to, the things that he wants for our society, are not the things that I want for our society."
Fetterman used closed captioning monitors at the debate due to auditory processing difficulties caused by the stroke that he says almost killed him.
"I might miss some words during this debate, mush two words together," he said, addressing what he called the "elephant in the room".
"It knocked me down, but I'm going to keep on coming back up."
Fetterman spoke haltingly and sometimes missed words in a performance described by Senator Toomey as "painful" to watch.
Advocates for people with disabilities hit back, arguing the criticism was a sign of stigma and ableism in the workplace.
In the media, speculation about Fetterman's health eclipsed discussion about the policy issues debated on the night.
Control of the US Senate remains a 'dead heat'
The Senate makes or breaks the passage of federal legislation and is also tasked with approving or blocking presidential appointments, such as Supreme Court judges.
Senators serve staggered six-year terms, meaning roughly a third of their seats are up for grabs this election day on November 8.
While forecasters FiveThirtyEight are tipping a "dead heat" in the Senate, Republicans are widely expected to win the House of Representatives where all 435 members face re-election every two years.
Losing control of the House would make it more difficult for Biden to prosecute his agenda, and could enable a series of partisan investigations, including into the president's son Hunter Biden.
Some Republicans have suggested they would also seek to impeach the president.
So, while Biden isn't on the ballot at the midterms, held at the halfway point of a presidential term, the results could cause him major problems.
And when it comes to the issues likely to sway votes, there is an overwhelming concern for many: the economy.
'I fell in love with Trump': Former president looms large in battleground states
Up until recently, Holly Purcell was a lifelong Democrat.
She cried when Biden decided against running for president in 2016 before voting for Hillary Clinton.
Eight years later, she has switched parties, officially registering as a Republican.
"It wasn't easy, it really wasn't," she said.
"It was a tough decision to make and I didn't make it lightly. But I'm glad I did."
Holly and her husband Stephen invited the ABC to the machine parts workshop outside Harrisburg that has been in their family for more than 50 years.
With inflation reaching historic highs, they say they have never been more worried about where the US economy is headed.
"Materials, the tools we use to make parts, everything has gone up in price. Our wages for the employees, that's increased," Mr Purcell said.
"All those kinds of pressures have caused us to increase the cost to the customer.
"In my memory, it's been the biggest issue our company has faced."
Dismayed by Biden's handling of the challenge, and unconvinced by Fetterman's platform, the Purcells are voting for Dr Oz.
They also hope Trump will run for president again in 2024.
"I've come around to Donald Trump. I didn't like him at first, I didn't like his personality," Ms Purcell said.
"But he did what I think needed done in the long run.
"I want to see his policies back, I want to see things being made in America, I want to see the border being patrolled better, I want to see the wall."
Mr Purcell describes himself as libertarian who has previously backed candidates from both parties.
"I took a chance with [Barack] Obama, I wasn't happy with everything I saw out of that," he said
"And I fell in love with Trump. I thought he spoke to me."
Democrats lean into abortion rights
On the other side of the spectrum is Karin Guerrini, a registered Republican who cannot bring herself to vote for any of the party's candidates, including Dr Oz.
"Over the years I've never really liked him," she said.
"He had all these potions to fix everything. And it seems like he was getting rich and making these suggestions that really didn't work."
Ms Guerrini is also concerned by the party's position on abortion in the wake of the Supreme Court's decision to overturn Roe v Wade and hand power back to the states.
In a comment seized upon by Fetterman's campaign, Oz told the debate that abortion policy should be decided by "women, doctors, local political leaders".
The Republican candidate for Pennsylvania governor, Doug Mastriano, said in 2019 that women who violated his proposed abortion ban should be charged with murder.
Democrats have tried to galvanise support over reproductive rights, with Biden promising to codify Roe v Wade if his party can secure enough seats in Congress.
But poll after poll suggests voters are more concerned with issues that tend to favour Republicans, including the economy and crime.
And some Democrats worry the momentum gained immediately after the court's decision has been lost.
Sharee Livingston, a physician specialising in obstetrics and gynaecology who spoke at an abortion rights rally on the steps of Pennsylvania's state capitol building, disagrees.
"I have faith in humans. Humans know right from wrong and we have not lost momentum," she said.
"We are going to vote in the direction that will put us in power and provide us with safe, affordable abortion care."
Is democracy on the ballot?
Regardless of the outcome of the midterms, many of the voters the ABC spoke to shared a common anxiety about the level of political division in their country.
"It seems now that people judge you if you're Republican or Democrat," said Shirley Manning, an 87-year-old who has vowed never to discuss politics or religion.
"Some people are so diehard to one party that's how they pick their friends. And that is not the way of life."
The midterms are the first major elections since the January 6 attack on the US Capitol and while Democrats argue democracy itself is on the ballot, Republicans have accused the president of trying to divide the nation further.
Trump's endorsement of candidates who support his false claims that the 2020 election was stolen — including Doug Mastriano in Pennsylvania — has prompted concern about how so-called "election deniers" will respond if they lose their own races.
It could also create further uncertainty ahead of the next presidential election in 2024, especially if Trump decides to run again.
The midterms circus might be drawing to a close, but these elections could shape US politics for years to come.
