Pope John Paul's Health Cause for Concern
AARON BROWN, CNN ANCHOR: Good evening, again, everyone. The health of Pope John Paul II, as you may know, has taken another turn for the worst today. How big a turn is still unclear. The questions outnumber the answers tonight. But this much we know. The Vatican says the pontiff is being treated with antibiotics for a high fever caused by a urinary tract infection. CNN's Rome bureau chief, Alessio Vinci, starts us off tonight. We have a little more information now, don't we?</s>ALESSIO VINCI, CNN ROME BUREAU CHIEF: That is correct, Aaron. Information that came to us last night here in Rome, and that is that the pope has been diagnosed with a high fever, first of all, and that it was treated with antibiotics. That high fever given to him because of a urinary tract infection. The Vatican officials last night, before going to sleep, told us that the pope is responding well to treatment and that nevertheless, however, his condition remains serious. So much in fact that one Vatican official is telling us that the pope has received what is known as last rites or the sacrament of the sick, which is a blessing. That does not necessarily that the pope is in an imminent death situation. It is a blessing that can also be performed on patients who are very sick. And this appears to be the case with the pope. It is not the first time this blessing was given to the pope. Actually back in 1981, when he was shot in St. Peter's Square, the pope received that same kind of blessing. As you know, of course, the pope survived that attack. And finally, Aaron, the medical sources here in Rome are telling us that at this time there are no provisions to take the pope back to the Gemelli Hospital where he has spent several weeks in the past few months. This, of course, can be interpreted in two ways. Either the Vatican doctors are confident that they can deal with this situation at the Vatican with the equipment that they have there. And it is indeed top of the line equipment to deal with the pope. Or that perhaps the pope is so sick, so frail, that basically it is too dangerous to take him to the Gemelli Hospital. But the situation at this time remains, again, extremely serious. Back to you, Aaron.</s>BROWN: But at what point in the day, if we know, do we expect to get the next medical bulletin, if that's the right way to frame it?</s>VINCI: Well, we do know that the Vatican press office opens at 9 a.m. local time. That's about three hours from now. We do expect I believe later on, perhaps, a bulletin or medical update from Dr. Joaquin Navarro-Valls, who is the Vatican spokesman, himself a physician. We do expect some kind of an update from the pope from the Vatican. Of course, this, as you can imagine, Aaron, in the last few hours, the world's media descended on Rome and all of us are craving for more information and the Vatican will have to give us something about the pope later on today.</s>BROWN: Yes, we are. Alessio, thank you. Alessio Vinci in Rome where it's 6:00 in the morning, a little past that. By any stretch it's been a tough week for Pope John Paul II, unable to speak on Easter Sunday to the crowds gathered at St. Peter's. Unable to speak yesterday as well during his weekly general audience, looking very, very ill and frail yesterday. The Vatican announcing that he had been given a feeding tube inserted in his nose to help provide nutrition as he recovers from a tracheotomy, and now this additional setback. We're joined now by CNN senior medical correspondent Dr. Sanjay Gupta, and here in New York, Dr. Simon Hall, who is the chairman of the Department of Urology at Mt. Sinai School of Medicine. So Dr. Hall, let me turn to you. Urinary tract infection, unusual in a Parkinson's patient who has gone through what the pope has gone through in the last couple of months?</s>DR. SIMON HALL, MT. SINAI SCHOOL OF MEDICINE: No, I think it's not unusual. We know that Parkinson's patients can have bladder dysfunction. They may not empty their bladder particularly well. He's also elderly. He probably had some prostate problems on top of that, which can worsen. And he's been debilitated for some time. We don't know, perhaps he's even had a catheter draining his bladder already, which could either be the cause of this infection or he needed a catheter as he wasn't emptying very well and now has gotten -- had an infection.</s>BROWN: Sanjay, it's sort of axiomatic and it may also be true that hospitals are dangerous places, at least where infection is concerned. It's a place you can pick up infections, do you agree with that?</s>DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Absolutely. And some of the most dangerous bacteria actually are in hospitals because that's where a lot of antibiotics are used. So the bacteria that survive are particularly bad ones, Aaron.</s>BROWN: The blood pressure question. What causes the blood pressure to drop?</s>GUPTA: Yes, that's a concerning point. What could possibly cause the blood pressure to drop is if this infection was particularly a bad infection. We've heard that it's isolated to urinary tract as we just talked about. But if it had gotten into the bloodstream for example, that could cause some problems with his blood pressure. We don't know that for sure, but that's one of the first things that pop into mind as a doctor.</s>BROWN: Dr. Hall, I'm curious about the first things that pop into your mind as a urologist here. Is the concern that it is a urinary tract infection or is it a concern that somewhere in the pope's system, anywhere in the pope's system, he has a serious infection that they're having to aggressively treat? Is that the problem?</s>HALL: Well, I think certainly the fact that he has a high fever and perhaps there are some issues with his blood pressure would be more than just a simple bladder infection, that this sounds more like there perhaps are either bacteria or the toxins from bacteria in his bloodstream.</s>BROWN: And tell me what that means medically.</s>HALL: So we'd call that sepsis, that perhaps he has what we call urosepsis, which would mean that he has bacteria in the blood that originated in the urinary tract. And part of the reaction to body is that you may have a low blood pressure. You may have trouble keeping a good blood pressure. And that worst case that somebody may have problems oxygenating. They may have changes in mental status. And in worst case...</s>BROWN: Tell me what oxygenating means.</s>HALL: So that they may not be able to get enough oxygen to their tissues, to their heart, to the vital organs to the brain. And they may not -- in order to make up for that, they'll have to breathe very rapidly, and we already know the pope had some issues with that already.</s>BROWN: I suspect -- what I'm trying to delicately ask, and what in the end people really want to know, is how dangerous a situation is this? Is the pope's life threatened?</s>HALL: Well, I don't know. I don't know if I would say I have enough information to say...</s>BROWN: Fair enough.</s>HALL: ... but certainly we know he's been ill for some time. He's, I'm sure, quite debilitated since he needed to have a feeding tube for nutrition, and now on top of it has -- certainly sounds more than just a routine bladder infection, that he's quite ill. And it's unclear whether he would be critically ill or just seriously ill, whether he needs to be on medication to keep his blood pressure where we would like it, and whether or not he needs to be on a ventilator so he can -- to breathe for him. So we don't know that right now. So I think that certainly someone goes on antibiotics. We know that usually someone will react well and within about 24 hours. But sometimes the insult may be too much. That even with the correct antibiotics, the body is unable to recover from the insult from having bacteria in the blood. Time will tell.</s>BROWN: Sanjay, give you the last word. You want to give a second opinion on this?</s>GUPTA: No. I agree with that. A couple of months now, though, we've been talking about the pope. He was hospitalized for 10 days in the beginning of February. Then he got this tracheotomy. Then he got a feeding tube. Then he had a high fever now. They think it's isolated to urinary tract. If you weren't describing the pope and you talked about any man in his 80s with these significant medical problems who's now had this sequence over the last couple of months, it'd be very concerning, I think, to any doctor who's been following this case. So I'm concerned, as I think many doctors are and many people are tonight.</s>BROWN: I was going to say, I think all of us, whether Catholics, non-Catholics, medical people, non-medical people, people who are aware of the pope's impact on the planet over the last 25 years are concerned. Gentlemen, thank you both, appreciate it. This latest setback for the pope comes on the heels of two hospitalizations, as we mentioned, since February, both respiratory problems which have greatly diminished his public presence. He seems to have aged dramatically since the first of the year. The 84-year- old pontiff, he'll be 85 in about six weeks, has pulled through many health crises, but it's clear that each new one takes a toll. We're joined from the Vatican now by CNN Vatican analyst John Allen. John, it's good to see you. Obviously there is -- even before today, there was in the Vatican great concern about the pope's health. Can you tell if there is under way, as indelicate as this must seem, planning for his eventual death?</s>JOHN ALLEN, CNN VATICAN ANALYST: Yes, Aaron, I think the clear answer to that question is yes. Not in the sense that Vatican officials have any reason to believe that that's imminent, and we need to stress that. That while the situation has been properly described as one of grave concern, there is no sense at the moment that anything is imminent. But clearly Vatican officials have for some time known that this moment may come and it may come sooner rather than later. And so the series of events that would be triggered by the pope's death are already well-choreographed here. Vatican radio has plans in place to begin playing funeral music, when that moment comes, for example. The pope's Office of Liturgical Ceremonies has its sort of ducks in a row to begin the highly elaborate series of rituals that would be played. And obviously I think it's also fair to say that in the privacies of their own consciences, the cardinals themselves, those 117, as of today, cardinals who are under 80 and therefore would be eligible to vote in a papal election obviously have been preparing themselves for what they're going to have to think about and the challenges they're going to be facing when that moment comes.</s>BROWN: John, to the extent that there are day to day responsibilities for the pope, who has been doing them?</s>ALLEN: Well, that's a great question, Aaron. I think -- the truth is this: Everyone who has been in to the pope during this period comes out emphasizing that he remains fully lucid, fully aware of what's going on, able to absorb information and make decisions. So I think the truth is that when these decisions are made, and since the first of March, the pope has, for example, appointed 29 bishops, I think we all have to assume that he is at the end of that process saying either yes or no to those appointments. The other truth is that 99.5 percent of the work in preparing that appointment in making the decision is being done by others. And I think there is, by universal agreement, the four most significant others in the Vatican today, would be: his private secretary, Archbishop Stanislaw Dziwisz; Cardinal Joseph Ratzinger, who runs the Congregation for the Faith, that's the Vatican's doctrinal office; Cardinal Angelo Sodano, who is sort of the Vatican's top diplomat; and Cardinal Giovanni Battista Re, who runs the Congregation for Bishops. Certainly between them, those four men are carrying a lot of the weight today that ordinarily would rest squarely on the pope's own soldiers.</s>BROWN: John, as always, you know your stuff. Good to have you with us tonight. Thank you, John Allen who is in Rome. Vatican officials could someday soon be facing the kind of terrible medical decisions that so many families face every day and that seem to have dominated the national conversation for a long time around here, what steps should be taken, should his life be prolonged by extraordinary measures? And just what constitutes extraordinary these days? And of course, what may be the most central question: What does the pope himself want? From Rome, here's CNN's Jim Bittermann.</s>JIM BITTERMANN, CNN SR. EUROPEAN CORRESPONDENT (voice-over): In a number of different ways, senior churchmen are now laying the groundwork for papal medical treatment which could prolong the pope's long-term on respirators, feeding tubes, and fluid drips. For instance, in an interview with CNN, Cardinal Jorge Medina said using extraordinary means to keep a person alive depends on the person's role in society. And besides, he added, artificial respiration is no longer considered an extraordinary means. And the pope himself, in little-noticed remarks last year to a congress, called Life Sustaining Treatments in the Vegetative State, wrote this: "The administration of water and food, even when provided by artificial means, always represents a natural means of preserving life. Its use should be considered morally obligatory until it's seemed to have attained its proper finality." From that, churchmen have concluded the pope's will is to be kept alive even if he cannot breathe or eat or swallow. A Parkinson's specialist who has treated the pope says John Paul could survive for some time.</s>DR. FABRIZIO STOCCHI, PARKINSON'S DISEASE SPECIALIST: Some people live for ages in that situation if you think about prolonged coma because of a trauma or other things like that. They can live for years. Of course, the pope is old, and that could be a problem. And plus we have to bear in mind that a critical patient under that condition can actually easily get infections. And that might be a very important risk.</s>BITTERMANN: Dr. Stocchi says the pope's survival will ultimately depend on the strength of his heart, which he believes has been under increased strain as John Paul's breathing problems have worsened.</s>STOCCHI: The most important factor in the pope's situation today is actually the posture. The neck is bended and actually on the chest. And these lead the head to be positioned forward. And in this position, actually the breathing is not easy.</s>BITTERMANN: Medical and church sources say that while the pope has been away at the hospital, his apartments have been equipped with all he might need in the way of artificial breathing and feeding equipment. But Catholic moral theologians who deal with long-term care for the dying, say the most difficult issue is not whether to start artificial treatment, but when to stop it.</s>FATHER BRIAN JOHNSTONE, MORAL THEOLOGIAN: The basic question is whether the means of treatment are actually treating the patient, doing some good, or whether those means of treatment are only making things worse.</s>BITTERMANN: Church moralists like Father Johnstone advise Catholics all the time about the difficult choices involved in the care of dying loved ones. But it's clear that the pope's condition is leading to new examination of church values.</s>JOHNSTONE: If the pope continued to live and was being maintained by a respirator, say, for a long time, could you reach the point where it could be morally justified to stop? Well, for the reasons that I have already explained, the answer could be yes, but there could other factors in the issue concerning the pope's particular immense responsibilities which might add another item that would have to be weighed.</s>BITTERMANN: But who could possibly weigh such a question in the case of the supreme pontiff? (on camera): Father Johnstone says if a person is unable to decide for himself how long artificial care should continue, it's generally left up to his family. But in this case, he added, only the pope can decide. Leaving open the question of what would happen if the pope were to slip into a coma. (voice-over): The answer is clear for those here who, like the pope, suffer from Parkinson's. Ricardo Farina (ph), who is younger than John Paul, but who has had the disease just as long, believes those around the pope should never give up, even if he's at death's door. "Hope is the last thing to die," he says, "anyone who is sick thinks that way. If you believe in God, you only have to wait for the decision of God." While the church fathers are not facing any life and death dilemmas just yet, with the pope now breathing through a tube and barely able to speak, it's become apparent they may be soon. Jim Bittermann, CNN, Rome.</s>BROWN: Coming up on this special edition of NEWSNIGHT, how Catholics around the world are responding to this latest serious health crisis for the pope, and how John Paul II has changed the papacy forever. A break first, from New York, this is a special edition of NEWSNIGHT.