Vivek Ramaswamy was holding court before a crowd at a New Hampshire fair, the second of five stops on a typically busy day of barnstorming, when he did something rare: He yielded the spotlight.
A nurse had asked Mr. Ramaswamy, the entrepreneur-turned-author-turned-presidential candidate, about nurse staffing shortages at hospitals. But before addressing the question himself, he turned to the doctor nodding emphatically at his side — his wife, Apoorva Tewari Ramaswamy — and handed her the microphone.
“Trust me, I’ve been in his ear. He’s heard that from me, too,” Dr. Ramaswamy said reassuringly, both to the nurse and to hundreds of others listening. “We need so many people who are actually interacting with other humans and seeing what is going on.”
New to the public eye, Dr. Ramaswamy, 34, holds many titles: Yale-educated surgeon, cancer researcher and professor, mother of two.
Yet since her husband, 38, transitioned from making frequent appearances on Fox News to stumping in early primary states, Dr. Ramaswamy has balanced weekdays making hospital rounds with weekends on the trail, adapting to an everywhere-all-the-time campaign that puts their family — including their sons Karthik, 3, and Arjun, 1 — front and center. (One of her husband’s “commandments” reads: “The nuclear family is the greatest form of governance known to mankind.”)
The two display contrasting styles in appealing to Republican primary voters: Mr. Ramaswamy, a practiced debater, has an answer for everything, is quick to assert himself and seems alert to potential areas of disagreement, where he can interject to make a point. Dr. Ramaswamy is a warm and patient listener, leaning in, looking for common ground, and always smiling.
And where Mr. Ramaswamy has made his right-wing ideology, fast-talking combativeness and a tendency to embellish into something of a personal brand, his wife has sought to balance the needs of her husband’s candidacy against her interest in maintaining the life of a respected working professional.
Indeed, her work was central to a rare public disagreement: In July, Mr. Ramaswamy said on a podcast that he regretted receiving the Covid-19 vaccine. “Had I had the facts that I do now, as a young, thankfully healthy male, I would not have chosen to get vaccinated,” he said. In September, Dr. Ramaswamy said she did not feel the same about her own vaccinations.
“For my young, healthy husband, that’s a different decision than for me when I am taking care of patients who are cancer survivors, and they trust me to be in their airway every day,” she told NBC News. “Giving people that autonomy is the most important part.”
More recently, when asked if she recommended that others receive the vaccination, in accordance with C.D.C. guidance, she carefully sidestepped the question: “I recommend that people make their decisions based on the risks and benefits that have been published — and the risks and benefits should be investigated in a fair and balanced manner.” She later said that their children were not vaccinated against Covid-19.
In interviews, Dr. Ramaswamy resorted to a few different moves in defending her husband: downplaying (“He says things in a way that sounds pretty dramatic, but when you actually read his proposals, they’re very reasonable”) or glossing over the details of his proposals and saying she stood behind him (“He has a different communication style than I do, but I agree with him and his principles on pretty much everything”), or ducking questions by saying simply that he was running for president, not she (“I’m not the candidate,” she said, when asked about his call to fire half the federal work force).
She also expressed disbelief at the strong reactions to Mr. Ramaswamy from some who might have been expected to share similar views. “What has been surprising is that people have, in the Republican Party themselves, had such an allergic reaction to someone who is an independent thinker, who actually represents a lot of what the Republican Party — in terms of the people who vote conservative — what we believe,” she said.
Dr. Ramaswamy ventured a bit further into the fray after the third Republican National Committee debate, in which her husband had mocked Nikki Haley as “Dick Cheney in three-inch heels” and then invoked Ms. Haley’s daughter’s use of TikTok to score another point — eliciting an angry “You’re just scum” in response.
Her husband’s performance was roundly derided. But Dr. Ramaswamy pushed back against suggestions that he was sexist, calling him “the most pro-woman man I’ve ever met.” She also jabbed back at Ms. Haley in an interview, saying, “Maybe she needs to expand her vocabulary.”
Candidates have often relied on spouses to sand their edges. Casey DeSantis, the Florida governor’s de facto second in command, has held solo events corralling “Mamas for DeSantis”; Heidi Cruz and Michelle Obama each took career breaks to support their husbands and soften their images.
Unlike them, Dr. Ramaswamy has tried to do all of that while still working Monday through Friday researching head and neck cancers, visiting with patients or performing surgeries to treat swallowing disorders. Should her husband make it to the White House — however unlikely polls suggest that may be — she said she would keep working, describing medicine as her calling.
On Saturday in Ankeny, Iowa, at the first campaign event centered on Dr. Ramaswamy, about 35 people gathered in a cafe to hear her talk about her family and her faith as she balanced Karthik on her lap about half the time. At one point, when asked if her husband had ever frustrated her, she responded: “The same guy who thinks that lots of things are wrong, and he has to fix them? Yes.” The audience laughed.
“She’s someone you could meet in real life and have over to your house,” said Jem Gong-Browne, who said she had not yet decided on a candidate. “I’ve seen a video of him. He comes across as very alpha, and she’s genuine — real.”
Colleagues at Ohio State University, where she is a laryngologist and professor, praise her innovative mind; friends gush about her devotion to her sons. The juggling act, they say, is one that she was accustomed to long before her husband’s run.
“She was trying to balance residency with her private life, and that’s very difficult to do,” said Eli Sofer, a doctor who trained with Dr. Ramaswamy. “She wants to be a good mother, a good wife, and she’s very, very talented in the sense that she’s able to balance all of that together.”
Her newness to politicking comes in glimpses: hesitation before she answers a question, minor word jumbles while addressing large audiences. But she is adept in other ways, shaking hands with voters in tandem with balancing a toddler on one hip or greeting journalists by name. She says she has “loved this process,” even if she hadn’t envisioned it.
Dr. Ramaswamy moved with her family to the United States from India at 4 — something her husband makes reference to in saying their parents “came here legally,” before calling to overhaul immigration policies. (She became a citizen while in college.)
She graduated from Yale, then met her husband at a party while she was at medical school there and he was at law school.
Dr. Ramaswamy hadn’t been politically active. Growing up, she said, she had been taught to “keep your head down, control what you can control.” Politics, she said, “was never something we paid attention to.”
That changed after she became a parent, she said: “You realize you might not be interested in the government, but the government is definitely interested in you. And the decisions they make affect our day-to-day lives.” So when her husband raised the idea of a presidential run last November, she came around.
She has supported Republicans — and donated $10,000 to the Ohio Republican Party in 2021 — but said she did not vote in 2020 because she was busy with her medical fellowship and a newborn child.
Dr. Ramaswamy said the couple has also solicited advice about being in the public eye from Mr. Ramaswamy’s law school buddy, Senator J.D. Vance of Ohio, and his wife, Usha.
What she is most passionate about is her work. No matter the presidential race’s outcome, she has every intention of continuing to treat cancer patients, from whom she says she learned a powerful lesson on prioritization.
Cancer survivors, Dr. Ramaswamy said, “know what’s important, they know what gives them that sense of purpose — spending time with their family, being able to work in their job — and that is so important to me, being able to help them sustain that.”
It’s something her husband repeatedly praises on the stump.
After Dr. Ramaswamy spoke at the New Hampshire fair, he took back the mic, saying, “I am proud to be a presidential candidate who comes home in the evening and knows that my job during the day wasn’t the more important of the pair.”
Addison Lathers contributed reporting from Ankeny, Iowa.
