Vatican is upbeat on pope's condition

ROME -- On the day after Pope John Paul II was rushed back to the hospital for surgery to help him breathe, Vatican officials yesterday painted a positive picture of his condition, and said that the pope was breathing on his own and resting.

Vatican spokesman Joaquin Navarro-Valls said the 84-year-old pontiff would remain in Rome's Gemelli Polyclinic hospital, where his team of doctors advised him not to speak for a few days after the procedure, which required cutting a small breathing hole in his neck and inserting a tube.

Navarro-Valls denied media reports that the pope had been put on a respirator to help him breathe, and said the pope was healthy enough to eat breakfast, which he said included a café latté, 10 small cookies, and yogurt.

But longtime Vatican observers were skeptical of the Vatican's upbeat tone in describing the second hospitalization of the increasingly frail pope in less than a month, and Catholics openly speculated about whether he was healthy enough to continue to lead the church, and wondered what would happen if he was incapacitated.

The pope's most recent health crisis began Thursday when the pontiff, whose health has deteriorated steadily as his Parkinson's disease has progressed, was taken to the hospital suffering from acute breathing trouble.

It was his second respiratory crisis in less than a month, and the Italian media reported that this episode was more severe than the last. He underwent surgery Thursday night to cut a hole into his throat and insert a breathing tube in a procedure formally known as a tracheostomy.

Navarro-Valls said the treatment ''was not an emergency procedure."

Geriatric specialists in Boston said the pope's frailty could complicate his recovery.

Still, the Vatican's report yesterday that the pope was suffering from constriction of the voice box or larynx but no longer has a fever and is breathing on his own suggests that he could recover enough to leave the hospital within a few days, according to Dr. Ken Minaker, chief of the geriatric medicine unit at Massachusetts General Hospital.

''The usual treatment" for swelling, stiffening, or spasms of the larynx ''is high doses of anti-inflammatory steroids and time," said Minaker. ''Normally, it would be two or three days" and then the breathing tube could be removed and he could go home. Doctors would probably try to get him out of bed and walking as soon as possible to avoid complications that can be caused by prolonged bed rest in the elderly.

Minaker said the tracheostomy tube, inserted in the pope's neck Thursday, allows him to breathe more easily, avoiding the blockage in the larynx. Doctors can also suction out secretions through the tube.

Doctors would probably try to wean him back into normal breathing by capping the tube for short periods of time. The tube could also be left in place if the pope continues to have trouble breathing. In the meantime, the pope can eat normally, since the opening of the esophagus, through which food passes to the stomach, is above the voice box. However, he cannot speak unless the tube is blocked off or replaced with a ''talking tracheostomy."

Based on the Vatican reports, Minaker said, the bigger risk comes from the pope's Parkinson's and frailty and the possibility that he might develop a bacterial infection, such as pneumonia. The voice box constriction, he said, ''is likely a small event in an otherwise much more complex and threatening illness." He said doctors are probably prescribing antibiotics to prevent pneumonia.

The pope's problem with his larynx may have been a result of his age and Parkinson's, both of which cause stiffening, or may have resulted from irritation caused by excessive coughing because of a respiratory virus, Minaker said. If the larynx became constricted enough, it could close off his airway or make it impossible to cough up secretions -- both reasons to perform a tracheostomy. (Tracheostomy is the preferred medical term for what is commonly called a tracheotomy.)

Dr. Lewis Lipsitz, chief of gerontology at Beth Israel Deaconess Medical Center, said of the reports describing the pope's treatment: ''This is an attempt to allow him to recover more effectively than he could on his own. What we hope is that with some time to clear the airway, improve expansion of lungs, and clear secretions that this will be the road to recovery. But he's in a very precarious situation."

At the hospital, a small crowd of well-wishers and patients gathered and burst into applause when Navarro-Valls told the hundreds of reporters that the pope's condition was improving and that he was breathing more easily and had had a night of ''tranquil rest."

Throughout the day, people flocked to the hospital. They came with rosaries and Bibles in hand to say prayers. Dignitaries and diplomats mingled with a few men from a nearby construction site who came to say a prayer on their lunch hour.

Navarro-Valls said the pope had been informed of his situation and gave approval for the operation.

But the spokesman added that the pope wrote a note, which he said was penned in jest, on Thursday night in which he asked his concerned aides, ''What did they do to me?"

''I am always 'totus tuus,' " Navarro-Valls quoted the pope as writing. ''Totus tuus" is John Paul's Latin motto translated by his spokesman as meaning, ''I am completely in your hands."

Stephen Heuser of the Globe staff and correspondent Alexandra Salomon contributed to this report from Rome. Material from news services also was used.