The pope’s doctors did not think he was going to make it.
“It’s terrible,” Pope Francis gasped during a breathing crisis last month. The pope, his hand bruised with needle pricks and his oxygen saturation dipping to a dangerously low 78 during his long hospitalization, acknowledged in a failing voice that he might die. He held his doctor’s hand.
Francis had ruled out intubation, which would mean being kept unconscious, the leader of the medical team, Dr. Sergio Alfieri, said in an interview. So his doctors decided to treat the pneumonia in both his lungs with a last-ditch barrage of drugs that risked damaging his organs.
The pope’s closest aides had tears in their eyes as doctors asked the pope’s personal nurse, empowered to make life-or-death decisions, for permission to go ahead with more aggressive treatment. He consented and, ultimately, the pope responded positively.
Even so, the worst had not yet passed. Less than a week later, Francis regurgitated some food and started choking. The doctors, fearing he might die on the spot, immediately suctioned his airway but worried that the inhalation would aggravate his deeply infected lungs. His chief doctor worried all was lost.
But it was not.
On Sunday 38 days after he entered the Agostino Gemelli hospital, Dr. Alfieri discharged the leader of the Roman Catholic Church to return to the Vatican. He implored his patient, who had resisted going to the hospital in the first place, to rest and convalesce so as not to waste the chance he had been given.
“It was a miracle that he left the hospital,” said Dr. Alfieri, adding that the pope was now “not in danger.”
But when Francis made a brief appearance over the weekend, the public received a sobering glimpse of the toll the health crisis had taken on the 88-year-old pope. Greeting well-wishers from a hospital balcony, his voice was so weak it bordered on inaudible, his breathing so strained it sometimes looked like he gasped for air.
“You can see the decline,” Carlos Aguirre, a pilgrim from Colorado Springs said as he watched Francis struggle to speak.
Francis’ doctor said the pope agreed to a two-month convalescence that would put him on the road to full recovery. But prelates close to Francis are guarding against the possibility that his frail state is really the new normal. They have depicted his physical weakness as a powerful teaching moment about human dignity, and argued that his evident lack of energy has no bearing on his authority, even if it temporarily loosened his hands-on style of governance.
Over the next two months, Francis will be less visible, harder to hear, more cloistered and more likely to stick to the script. The constraints, Vatican experts and officials say, will be a challenge for Francis, who, over the last dozen years, made far-flung travel, physical closeness to his flock, dramatic gestures and a freewheeling style the hallmarks of his pontificate.
Those touchstones of Francis’ papacy will now be on hold. The Vatican said on Thursday that the pope’s participation in Easter rites in a special Jubilee year is uncertain, depending on his improvement.
Buckingham Palace announced that King Charles III had postponed a Vatican visit, “as medical advice has now suggested that Pope Francis would benefit from an extended period of rest and recuperation.” A papal schedule once packed with appearances has given way to written statements and remarks.
“Nothing will be as scintillating as it was before,” Alberto Melloni, a church historian and the director of the John XXIII Foundation for Religious Sciences in Bologna, said of Francis’ convalescence.
Dr. Alfieri said he instructed the pope to keep to his Vatican residence, which would be outfitted with oxygen but no other special equipment, and Francis agreed. He implored the pope to avoid large groups and especially exposure to small children, for fear of new infection.
During that time, he will take oral medications in the hopes of definitively curing his lung infection. He said the pope could work but should not overly exert himself for the time being.
“His voice will return as before,” as Francis’ respiratory muscles strengthen, Dr. Alfieri said. Anything could happen given the pope’s age and history of illness, he said — Francis has had respiratory ailments throughout his life, including one that required removal of part of a lung when he was a young man. But the doctor said he expected that over time, Francis could increase his workload as long as his health held.
Vatican analysts said that while the pope has been lying low, he runs the church as before.
“He is able to command even from a bed,” said Sandro Magister, a veteran Vatican watcher. “Knowing his character, he would react quite harshly to any attempt to keep him, let’s say, under control.”
Some of Francis’ allies in the Church hierarchy went further, saying his frailty was a new attribute that would allow him to embody his own teachings.
“People say he doesn’t speak, he doesn’t speak with his mouth,” Archbishop Vincenzo Paglia, president of the Pontifical Academy for Life, said while introducing a summit on longevity at the Vatican. The pope’s condition amounted to a “deafening voice” for the reality of human limits and the dignity of old age, he added. “We have to get out of an overly functionalist mind-set.”
Much the same was said two decades ago of Pope John Paul II as he deteriorated in public view, his body hunched and trembling, his head slumped to one side. It is likely to become an increasingly common theme as popes, like everyone else, live longer, a societal change that prompted the Vatican’s summit this week on longevity.
Francis’ predecessor, Benedict XVI, stepped down at 85, citing his age and frailty — and then lived another decade.
Weeks after Francis came close to death, his gradual improvement was a relief to his doctors and the Roman Catholic faithful.
Dr. Alfieri said that when the treatment started working and the pope’s health improved, his humor did too. He had his staff order pizza for the hospital floor, and went into the halls so that his fellow patients could see him and have a shared sense of their common vulnerability.
When it came time for Francis to leave, and he changed in his room into his white cassock and zucchetto, Dr. Alfieri was not just the pope’s physician.
“To see the pope,” he said, “who was dressed as a patient in pajamas, and then to see him again dressed as pope, is certainly, for a Catholic, an enormous feeling.”
Elisabetta Povoledo contributed reporting from Rome.
