‘A Complex Picture’
Four days after Pope Francis was taken to the hospital to be treated for acute bronchitis and fever, I flew to Rome for an unruly mix of motives, professional and personal. In my gut I felt the prospect of his passing, and as his biographer, I did not want to miss this final chapter. I wanted to be near him, or at least near to the flow of information about him, as one might move to be near an ailing elderly relative who has played a major role in one’s life. During more than one of many interviews that fortnight, when asked what he was like and how it was to be with him, I found myself choking up.
There’s that well-worn Lenin adage about decades when nothing happens and weeks when decades happen. By the time I arrived on February 18, the diagnosis had darkened both for the pope and for the world. It is odd how grief pushes all else away. The collapse of the postwar global order, with the government of the United States turning on the West and embracing Putin, seemed not just unbelievable but also remote, abstract, hard to get a handle on. Yet what was happening with Francis was immediate and clear—laid out, at his insistence, in sometimes shocking detail in the medical bulletins and informal briefings we received each day at the Vatican press office.
As a twenty-one-year-old seminarian in Buenos Aires, Jorge Mario Bergoglio almost died from pleurisy and survived the removal of part of one lung. Now, he was fighting for his life again at the age of eighty-eight, this time with double pneumonia. A polymicrobial infection in both lungs—not just bacteria and viruses, but fungi and other microbes—had set in after weeks of chronic bronchiectasis with asthma. The antibiotic treatments weren’t working, he needed oxygen, and although most days he was “stable,” it was clear he was struggling in the little papal suite—a hospital bedroom, chapel, and side room for the medics—on the tenth floor of the huge Gemelli Hospital, twenty minutes north of the Vatican.
Then, soon after I arrived, Francis seemed to rally. The therapies were changed and the fever subsided, if not the infection. We began to hope. But on February 21 we were summoned to the Gemelli for a press conference. The pope had asked his doctors to brief us, so that we could have a full, realistic picture. He had never hidden his health issues. He even once invited a friend, the Argentine doctor Nelson Castro, to write a book about the health of the popes, in which the final chapter was a detailed chronicle of Francis’s ailments, from his gallstones to his neuroses.
“He wants us always to tell the truth” about his condition, said the pope’s surgeon, Sergio Alfieri. Dr. Alfieri, a tall man with glasses who is a natural performer, spoke alongside the pope’s regular doctor, Luigi Carbone, who is shorter and somewhat shy. As the pope had directed, they didn’t sugarcoat the situation. It felt like the moment when the hospital doctor sits a family down and breaks it to them gently but clearly that they might not be able to save their elderly relative. Alfieri, who has twice operated on the pope, said that Francis had improved since being admitted, but that it was still touch-and-go. The pope was battling bilateral pneumonia and was in danger. The main risk was sepsis, when the germs pass from the lungs into the bloodstream and infect the organs. He was holding up, but he was frail. The risk of further infection meant that, apart from his two priest secretaries who were with him much of the time, he was not allowed visitors.
An exception had been made the previous day for a twenty-minute visit with the Italian prime minister. Giorgia Meloni, who has developed a strong bond with Francis, had reported afterwards that the pope was in good spirits. He joked with her that, while some were praying for him to enter paradise, the Lord of the Harvest seemed to think he should stay put for now. “The doctors said I must take care of my health, otherwise I will go straight to paradise,” she said he had told her. Alfieri confirmed to us that Francis was wholly obedient and cooperative, despite his reputation as an “impatient patient.” He was not bedbound: he sat in his chair, spent time in the chapel, read the newspapers, and did some light work. His heart was strong. He was in good spirits, humorous, and alert, and he “was not one to give up.” But yes, his lungs were in poor shape. He was receiving a heavy medication load, which had side effects. There would be good days and bad days ahead. And while the objective was to get him back to the Santa Marta, it wouldn’t be any time soon.
The doctors’ briefing poured cold water over the optimistic assumption among some of us that “stable” meant he was improving. Having planned to stay only one week, I extended my visit to Ash Wednesday. Each day I joined the journalists’ daily routine. It began with the 8:30 a.m. update, a brief report of the sort a nurse might give concerned relatives: “He is resting after a quiet night and breakfast.” Then, in the late morning, Holy See press director Matteo Bruni swung by to fill out the picture. But the important news came in the evening, when the medical bulletin landed in our inboxes around seven. The press office, where dozens of us gathered, suddenly hushed as we took it in. Then Bruni came out to answer questions the best he could, not being a doctor. If the news was bad, you could see it in his face.
Two phrases in the bulletins were constant. One was the quadro complesso, the “complex picture.” It was complex because a polymicrobial infection on top of a respiratory-tract infection in an eighty-eight-year-old with a preexisting pulmonary condition was never simple, and because the treatments had an impact on the organs—steroid-induced diabetes, for example—that could require additional treatment. On February 21, he needed blood transfusions in response to a low platelet count; two days later, he was diagnosed with kidney failure. Hence the other phrase we kept hearing: la prognosi rimane riservata. It was “reserved” because they didn’t know if he was going to make it. So one day’s news—that he was stable and responding to treatment, or had experienced sudden setbacks—was just that: you couldn’t draw conclusions as to the prognosis. Whenever there were apparent signs of either improvement or the reverse, the bulletins reminded us that they were within the overall quadro complesso. As Alfieri had warned us, there would be good and bad days.
This was tough on the ever-expanding crowd of reporters sent to cover what news desks assumed would be, at some point, a papal death followed by a transition. (Staying one step ahead of the news, The New York Times published a March 3 guide to “What Happens When a Pope Dies”) In addition to the usual five hundred accredited, Rome-based vaticanisti, another seven hundred media people had been given Holy See press passes since the pope went to the hospital. Covering news is costly, and editors wanted to know which way it would likely go. So we argued over how to interpret the data, comparing notes. Was X evidence of slight improvement, a sign he was rallying? Was Y proof of terminal decline, or was merely a small “setback”? Was “stable” over three consecutive days a sign that he was on the path to recovery, or was it a bad sign—an indication that, after two weeks, there was still no sign that the infection had been beaten by antibiotics and cortisone?
The views of specialists in other hospitals were helpfully rounded up each day in Q&A boxes in the Italian dailies, and many of us had doctor friends to help us interpret the information. But ultimately, no one could make the prediction that Alfieri and Carbone had refused to make: whether the pope was going to make it.
Two things all could agree on: if Francis pulled through, he would need a very long, strict convalescence. And the longer he stayed at the hospital with an infection, the lower his chances of recovery. This intuition seemed to be confirmed by sudden episodes of “respiratory insufficiency” requiring rapid action. No one could accuse the Vatican of holding back the grim details. We were told on February 28 that after inhaling vomit, the pope needed bronchial aspiration and supplemental oxygen via a mask. On March 3, two acute bronchospasms required the removal of mucus plugs by a tube inserted into his lungs.
On those days it seemed clear that his lungs were failing to cope with the infection. The pope was literally fighting for his breath. In our minds we no longer saw Francis frail and at peace but panicked, rasping, the doctors rushing to apply “non-invasive mechanical ventilation” in time. “Please, let him not suffer,” a friend told me in tears over the phone from Buenos Aires. She had worked alongside Francis for many years and adored him. Each day’s news was a dagger to her heart.
The two times the pope’s condition plunged, I felt it, too. My inbox filled with studio invitations: Should the worst happen, might you be available? Ignoring those, I did other interviews on Francis’s legacy, “to use when the time comes,” as well as others for the current moment. Worried about “papal biographer says…” headlines, I came up with a comms policy: I was happy to speak about the question of resignation and how Francis has reshaped the college of cardinals, but not about the next conclave—or even the movie Conclave, which for some journalists was an indirect way of speaking about the papal transition. The pope may be ill, I said, but he was still pope; unless he dies or resigns, there is no conclave in view. As one curial cardinal said to me, “Until the king is dead, the king is alive.”
The Catholic norm across the centuries is that a pope ages, gets ill, and then recovers or dies. Illness, brief or protracted, whether or not followed by death, is an integral part of the pontificate, a time to teach out of weakness, to show that a person does not lose his dignity because he has lost his strength, and that in our vulnerability we creatures discover better our dependence on our creator. There is also the witness of service and mission. A ministry is not a job, but a consecration. As Francis has magnificently shown us, a pope serves the People of God with a total self-giving, ad vitam: in sickness or in health, strong or frail, able-bodied or wheelchair-bound, clear in voice or raspy and breathless.
An ailing pontiff also allows us to give back. As I found in Rome, the prospect of losing Francis focused minds and opened hearts. It was a time for reflecting on the extraordinary spiritual gifts his pontificate has given us, but also for returning his devotion to us. When the pope ails, people head to St. Peter’s Square at night with rosaries or stand outside the hospital, as a group of Mexican women—shouting up “Ánimo, Santo Padre!”—did one day when I was there. This very Catholic bedside devotion is vital, and the witness it gives is priceless.
I have friends in the Curia who worry that Benedict XVI’s 2013 resignation set a poor counterexample in this respect. It is true that it was an act of great humility, a decision made after careful discernment. Benedict sincerely believed he had little time left and wanted above all to avoid what canonists call an “impeded see”—when the pope lives but ceases to govern, and others fill the void. Traumatized by what he had lived through in John Paul II’s last years, when the governance of the Roman Curia fell into an ecclesial form of gang warfare, Benedict stood down to avoid the same, according to his secretary, Georg Gänswein. Yet the fact is, Benedict resigned because of frailty, not because of a long-term degenerative or debilitating condition of the sort St. John Paul II had. He went on to live for almost a decade. And that, say my friends in the Curia, sets a difficult precedent, for illness or frailty are not reasons to resign. For this reason, it has been important for Francis to reestablish the ad vitam principle these past years. It is also why many believe he should not resign now.
Even during Francis’s three-plus weeks in the Gemelli, there was never an impeded see. As the communiqués constantly reminded us, most days he sat up in bed or in a chair reading the news and signing papers with his priest secretaries. He continued to sign off on new bishops, while cardinals led liturgies and prayers that included Francis’s messages signed “from the Gemelli hospital.” There are, of course, things only the pope can decide, which no one has the right to do in his stead. But most day-to-day Vatican business can proceed, if not on autopilot, then ad mentem Papam, following the overall directions he has given. For the more important matters, he continued to meet with the two senior figures of the Vatican’s Secretariat of State, Cardinal Pietro Parolin and Archbishop Edgar Peña Parra, just as he has done for years in the Apostolic Palace.
After the first of those meetings, on February 24, Parolin and Peña Parra returned with decrees approved by the pope to name two new saints and five new blessed. It was also announced that Francis had decided to “convene a consistory about the future canonizations,” with no date for it set. A consistory—a meeting of cardinals, usually attended only by those resident in Rome—is a routine step in the saint-making process, and usually nothing to get excited about. But in the press office it got us riled up, for it was at just such a banal consistory to set a date for canonizations that Benedict XVI announced he would resign.
Why at a consistory? Because Canon 332.2 says that for a pope to resign his office, “it is required for validity that the resignation is made freely and properly manifested but not that it is accepted by anyone.” He must be seen to be of sound mind and to be making a wholly free decision; speaking to a room full of cardinals is just about the best way of dispelling any doubts about that. Whether or not Francis will do the same, in that decree he has at least created an occasion for doing so, one he could make use of at any time.
Would he, though? This was the question I was most often asked during that fortnight. My answer was that the issue did not arise while he was fighting an infection in the hospital. And he had shown over these past several years that he had no difficulty as a pope with being frail, wheelchair-bound, and often unable to read out his texts. In his 2024 book Life, Francis had praised Benedict’s resignation as a humble, sincere decision, but went on to say it was a “distant possibility” for himself because “thanks be to God, I enjoy good health.” After Benedict died in 2022, Francis reminded the Jesuits that the papacy was ad vitam and papal resignations should not be the norm. But a distant possibility is still a possibility. If his health deteriorates to the point that it becomes a major distraction from the papacy, resulting in an impeded see, I think he would consider it, as would any pope.
As a Jesuit, Francis has spent his life seeking the magis, the greater glory and will of God above all else. As the pope’s full schedule before his hospitalization showed, preserving and prolonging his life is not his ultimate priority. Nor is remaining pope.
In a 2018 book titled La Barca di Paolo (“The Barque of Paul”), Msgr. Leonardo Sapienza, an official in the pontifical household, published a remarkable letter from St. Paul VI that he had unearthed in the Vatican archives. Paul had written the letter in 1964, very early in his pontificate. In it he declared that he would tender his resignation in the event of an “illness presumed to be incurable, or that is long-lasting, and which would impede the wholesale exercise of the functions of our apostolic ministry.” In that case, Paul wrote, he would entrust to the dean of the college of cardinals and the cardinal-prefects of the Roman dicasteries the task of accepting and acting on the resignation, which was made solely, he stressed, “for the greater good of the Holy Church.” In a letter to Sapienza dated December 8, 2017, Francis said he had read Paul’s letter “with amazement,” describing it as a “a humble and prophetic witness of his love of Christ and of the Church.” Faced with a society undergoing “vertiginous change,” Francis said, “Paul VI does not shy away from his responsibility.” Francis concluded: “What matter to [Paul VI] are the needs of the Church and of the world.” Repeating Paul’s words about a pope impeded by serious illness being unable to exercise fully the apostolic ministry, Francis said that Paul “indicates his precise will for the greater good of the holy Church.”
As I write, the pope’s prognosis has improved: many now expect him to finish recovering back at the Santa Marta. His lungs are finally able to function on their own, and experts say that, barring further infections, he should be able to resume an independent life. But the road to full recovery will be long; he will be vulnerable to further infections—meaning more episodes in the hospital. What will Francis decide to do in that case: Continue to offer his powerful witness of total service, a magisterium of frailty? Or follow the counsel of Paul VI and resign from office if that is what “the needs of the Church and of the world” seem to demand at this time of “vertiginous change”?
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