"Assuming the patient is in good health, the procedure is considered a delicate but simple one," Manni said. "Obviously, a banal procedure performed on a person as fragile as the pope can become serious."
Infectious disease experts in the United States said hospitalizations in quick succession represent a potentially ominous sign. The main concern is pneumonia, they said, an infection of the lungs that typically responds quickly to antibiotics but can be deadly in debilitated patients. Most pneumonias are caused by bacteria, although that bacterial infection is sometimes a secondary event following an initial viral disease such as a cold or influenza.
A nun holds a rosary and prays outside the Gemelli Polyclinic hospital, where the pope was being treated for problems associated with Parkinson's disease.
(Osservatore Romano Via AP)
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"Pneumonia is a mode of exit for many older people," said Martin J. Blaser, chairman of medicine at the New York University School of Medicine and president-elect of the Infectious Diseases Society of America.
Moreover, Blaser said, the fact that the pope was recently treated with antibiotics for pneumonia raises the odds that his current infection is being caused by bacteria resistant to standard antibiotics. Although stronger medicines are available, Blaser said, those medicines are typically more toxic and could take a toll on the ailing pontiff's health.
The tracheostomy and use of a breathing tube could complicate the pope's already damaged ability to speak. For the past two years, his voice has been gravelly and his words sometimes unintelligible. Aides often read his speeches.
He will not be able to speak at all with the breathing tube, doctors said. However, if the infection recedes and he can breathe without it, the tube can be removed and the incision in his throat closed. Tubes can also be removed temporarily, allowing him to speak at a particular time.
Normally, the inability to celebrate Mass would mean the end of a priest's career. However, in a recent issue of the Italian magazine Famiglia Cristiana, a church law expert said that what holds for priests does not necessarily hold for the pope. The pope can govern through written word and need not step down if he is mute.
In any case, the gravity of Thursday's surgery will undoubtedly renew the debate over whether John Paul should resign. At one point during the pope's first bout with the flu, Sodano said it was up to the pope whether to resign. That remark, in turn, elicited a defense of the pope's continued reign. His backers said that he was setting a valuable example of perseverance and that, in any case, the papacy is not a job that can be relinquished without very careful consideration.
Since his release from Gemelli two weeks ago, the pope had made two appearances at his Vatican apartment window for general audiences. During a third audience, on Wednesday, the pope appeared on a large-screen television from inside the apartment. Aides advised the pontiff to avoid exposing himself to blustery winds at the window. On Tuesday, he met with Croatia's prime minister, Ivo Sanader, the first time the pope had held a private audience with a politician since taking ill. The appearances were heralded by Vatican statements alluding to the pope's recovery from the flu and his ability to carry on church business.
Thursday's hospitalization was the 10th of the pope's 26-year reign. Some church officials jokingly refer to Gemelli as the Third Vatican, after Vatican City and Castel Gandolfo, the pope's summer retreat.
His mortality was a focal point this week when Vatican officials introduced a book of John Paul's recollections and teachings called "Memory and Identity." In it, he describes the immediate aftermath of the 1981 attempt by Mehmet Ali Agca, a Turkish gunman, to kill him. He said that upon reaching Gemelli hospital, he passed out. "I was practically on the other side," he said. "Oh, my God! It was a difficult experience."
Staff writer Rick Weiss in Washington and researcher Stacy Meichtry contributed to this report.
