The death of Sheldon Adelson on Monday at age 87 is undeniably the end of an era. The question now is whether the passing of the casino mogul, political megadonor and major force in the world of Jewish philanthropy marks the end of the Adelson era altogether or merely signals the beginning of a new chapter.

For the answer to that, all eyes now turn to his widow, Dr. Miriam Adelson, as she mourns the passing of her husband of some 30 years.

When it came to their professional lives, the boundaries between the couple were always clear.

Sheldon Adelson’s ever-expanding and phenomenally profitable casinos and associated business interests brought in the billions that comprised the family fortune. Few expect Miriam to take the reins of her late husband’s business empire, though stock holdings in his company are in both of their names.

Already established in her medical career when they met and married, she continued to work as a senior physician engaged in drug addiction research, donning her white coat to work at the Dr. Miriam and Sheldon G. Adelson Clinic for Drug Abuse Treatment & Research, which they opened in Las Vegas in 2000.

However, when it came to giving away their fortune to political and philanthropic causes, the Adelsons absolutely worked as a team, with Miriam actively involved – and, in some cases, the person driving their decisions.

So while it is unlikely that Miriam Adelson will transform into a casino mogul, she may well become a political megadonor and philanthropic force in her own right.

‘You have worked miracles’

It was perhaps with an eye on Miriam Adelson’s future generosity that President Donald Trump chose to present her with the Presidential Medal of Freedom in 2018, honoring her for “especially meritorious contribution to the security or national interests of the United States, world peace, cultural or other significant public or private endeavors.”

That ceremony took place in November 2018, with Sheldon Adelson making a rare public appearance before he disappeared for several months to receive treatment for non-Hodgkin’s lymphoma, only reappearing in April 2019 at the Republican Jewish Coalition.

The ties and level of mutual appreciation between Trump and Miriam Adelson were clear for many years. On the day the U.S. president moved his country’s embassy from Tel Aviv to Jerusalem in May 2018, she wrote effusively in the Las Vegas Review-Journal (of which she holds the title of publisher): “I am euphoric today – as an Israeli, as an American, as a human being who wants a better world. I feel privileged to be a witness to the bold leadership evinced by President Trump. Thank you, Mr. President. You have done the right thing. You have worked miracles.”

Continued substantial support from the Adelson coffers, now controlled by Miriam, is important not only to Trump as he looks ahead to a possible 2024 run (pending potential impeachment trial), but for his Republican Party as a whole.

In 2018, the Adelsons were easily the highest donors to any midterm election campaign effort, giving an estimated $113 million to the Republican Party. In 2016, they donated $5 million to Trump’s inauguration committee and sat prominently at the front as the president was sworn in outside the Capitol Building.

But that was nothing as compared to 2020, when the Adelsons reportedly spent $250 million backing Trump, Republican Senate and House members and conservative causes in the election year. Their donations included a reported $75 million to a pro-Trump Super Pac called Preserve America.

Part of the money went into Pacs and advocacy groups like the American Action Network, which funded a series of local television ads charging selected Democratic congressmen and women in swing districts of doing “barely anything” to counter Rep. Ilhan Omar’s “antisemitic slurs.”

‘No less accomplished’

Miriam Adelson surely never saw herself as an American kingmaker when she was growing up in Israel. Born in British Mandatory Palestine in 1946 to Menucha and Simha Farbstein, who fled Eastern Europe just prior to the Holocaust, she grew up in Haifa, where her father ended up owning several movie theaters.

She spent two years in the Israeli army, earned a bachelor of science degree in microbiology and genetics from the Hebrew University, and a medical degree from Tel Aviv University. Later, she became the chief internist in an ER at the since-shuttered Rokach Hospital in Tel Aviv.

As Dr. Miriam Ochshorn (her first marriage was to Dr. Ariel Ochshorn, with whom she had two daughters), she was an early proponent of the idea that addiction was a disease, not a life choice. In 1986, she moved to New York, where she worked as an associate physician at Rockefeller University. It was here she studied chemical dependency and drug addiction, focusing specifically on the spread of HIV among drug addicts.

She met the then-57-year-old Adelson on a blind date in 1991 and they were married within 100 days of that first meeting. She told Fortune magazine in 2012 that she got “stuck” in the United States after meeting Sheldon, “the love of my life.”

In a 2008 New Yorker article (“The Brass Ring”) that took a deep dive into Sheldon Adelson’s influence, when his dominance of the business and political realms was becoming clearer, journalist Connie Bruck wrote that according to those who knew him well, it was Miriam who intensified her husband’s commitment to Israel and shifted his political views substantially to the right.

Indeed, before meeting and marrying his second wife, Sheldon Adelson was in many ways a typical American Jew. Even though his cultural identity and ties to his heritage were strong, he showed few signs of the level of involvement in the Jewish state that the couple’s activities would later reflect.

It is highly unlikely, for instance, that a Miriam-free Sheldon Adelson would have made such massive contributions to causes like the Yad Vashem Holocaust memorial and museum; Birthright Israel; Friends of the IDF; the Zionist Organization of America; AIPAC; and, more recently, the Israeli-American Council; and the Anti-Defamation League.

And without her, it is unlikely he would be so deeply involved with Israeli politics and politicians – most prominently, Israeli Prime Minister Benjamin Netanyahu – or have founded the pro-Netanyahu Israel Hayom free daily newspaper (of which Miriam is also the publisher).

The 2012 profile in Fortune noted that Miriam Adelson was “no less accomplished – or powerful – than her larger-than-life spouse.” The couple, the article noted, didn’t spend even a day apart, and she told the interviewer that “Sheldon and I share the same vision and beliefs, although we come from two different backgrounds.

“We are in full agreement on the causes we support, whether they are helpless people, drug addicts or young people looking for roots in Israel,” she added. “We don’t have arguments, or long discussions; it’s a quite fast discussion bearing in mind our common values.”

They have differed in public so rarely that it made news when it did happen: During the 2016 presidential campaign, Sheldon Adelson seemed to prefer Sen. Marco Rubio of Florida while Miriam seemed to prefer Sen. Ted Cruz of Texas. Before they settled on Trump, Miriam appeared to be winning the argument – in the end they gave more money to Cruz, but ended up with Trump.

Over the years, she was particularly instrumental in her husband’s initiative to create a hard-line, right-wing alternative lobby to AIPAC. Since 2013, the couple has taken the Israeli-American Council and turned the group – once merely a community organization for Israelis living in the United States – into a national advocacy force for Israel, free of AIPAC’s need for bipartisanship and consensus.

At the group’s 2017 conference, Miriam Adelson said the group “will be our soldiers if, God forbid, something is endangering the State of Israel.” A year later, at the same event, she said that “if we are united, we can be a major force to help Israel.”

She has articulated her personal commitment to Israel’s welfare – and funded the Republican Party and pro-Israel nonprofits to protect it – on several occasions. In a 2014 interview with Hadassah Magazine, she admitted that though she diverges with the Republican Party on issues like abortion, “supporting a free-market society and Israel are more important issues.”

In a 2016 public conversation with Rabbi Shmuley Boteach – himself no stranger to the Adelsons’ largesse – Miriam Adelson said she saw international delegitimization as the greatest threat to Israel. This drove her desire to fund advocacy organizations to protect Israel in international arenas, she said, so the trauma her family underwent in the Holocaust never happened again.

She went on to explain how Israel informs her wider worldview. The Jewish state is the canary in the coal mine when it comes to the threat of Islamic extremism, she noted.

“The danger starts with the Jews, but we have to remember that after the Jews, the Free World is suffering,” she said.

It is statements like these that lead people to the conclusion that when her period of mourning ends, Miriam Adelson won’t simply retreat to her laboratories and luxury homes. Instead, she will take up the mantle of her husband’s political and philanthropic causes and continue the fight.

The worlds of politics and philanthropy are waiting with bated breath.