Pope Francis rested early Tuesday after he suffered further setbacks in his fight against double pneumonia: two new acute respiratory crises that required him to resume using noninvasive mechanical ventilation to breathe.
In its early Tuesday update, the Vatican said: “The pope slept through the night, now rest continues.”
Francis suffered the two crises Monday. Doctors extracted “copious” amounts of mucus that had accumulated in his lungs, the Vatican said in a late update. They performed two bronchoscopies, in which a camera-tipped tube was sent into his airways with a sucker at the tip to suction out fluid.
The 88-year-old pope, who has chronic lung disease and had part of one lung removed as a young man, was put back on noninvasive mechanical ventilation: a mask that covers his nose and mouth and pumps oxygen into the lungs.
Francis remained alert, oriented and cooperated with medical personnel, the Vatican said. The prognosis remained guarded, meaning he was not out of danger. Doctors didn’t say if he remained in stable condition, though they referred to the crises in the past tense, suggesting they were over.
The crises were a new setback in what has become a more than two-week battle by the frail pope to overcome a complex respiratory infection.
The Vatican said the mucus that had accumulated in Francis' lungs was his body’s reaction to the original pneumonia infection and not a new infection, given laboratory tests don’t indicate any new bacteria.
Dr. John Coleman, a pulmonary critical care doctor at Northwestern Medicine in Chicago, said the episodes were more concerning than the l ast one on Friday, in which Francis had a coughing fit, inhaled some vomit that needed to be extracted and then was put on the noninvasive mechanical ventilation for a day and then didn’t need it anymore.
The use of bronchoscopies reflects a worrying level of mucus and phlegm in the lungs, Coleman said. “The fact that they had to go in there and remove it manually is concerning, because it means that he is not clearing the secretions on his own,” he said.
“He’s taking little steps forward and then steps back,” said Coleman, who is not involved in Francis’ care.
Francis, who is not physically active, uses a wheelchair and is overweight, had been undergoing respiratory physiotherapy to try to improve his lung function. But the accumulation of the secretions in his lungs was a sign that he doesn’t have the muscle tone to cough vigorously enough to expel the fluid.
Doctors often use noninvasive ventilation to stave off an intubation, or the use of invasive mechanical ventilation. Francis has not been intubated during this hospitalization. It’s not clear if he has provided any advance directives about the limits of his care if he declines or loses consciousness.
Catholic teaching holds that life must be defended from conception until natural death. It insists that chronically ill patients, including those in vegetative states, must receive “ordinary” care such as hydration and nutrition, but “extraordinary” or disproportionate care can be suspended if it is no longer beneficial or is only prolonging a precarious and painful life.
Francis articulated that in a 2017 speech to a meeting of the Vatican’s bioethics think tank, the Pontifical Academy for Life. He said there was “no obligation to have recourse in all circumstances to every possible remedy.” He added: “It thus makes possible a decision that is morally qualified as withdrawal of ‘overzealous treatment.’”
Archbishop Vincenzo Paglia, who heads the academy which helps articulate the Catholic Church’s position on end-of-life care, said Francis is like any other Catholic and would follow church teaching if it came to that.
“Today the pope is giving us an extraordinary teaching on fragility,” he told reporters Monday. “Today the pope, not through words but with his body, is reminding all of us, we elderly people to begin with, that we are all fragile and therefore we need to take care of each other.”
Francis’ hospitalization, which hits 18 nights Tuesday, is by no means reaching the papal record that was set during St. John Paul II’s numerous lengthy hospitalizations over a quarter century. The longest single hospitalization occurred in 1981, when John Paul spent 55 days in Gemelli for a minor operation and then to be treated for a serious infection that followed.
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