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Pope develops high fever in latest health setback

Friday, April 1, 2005

VATICAN CITY -- Pope John Paul II was responding to treatment with antibiotics and his condition appeared to have stabilized after he suddenly developed a high fever brought on by a urinary tract infection, Vatican radio reported early today.

The latest health crisis for the 84-year-old pope came one day after he began receiving nutrition through a feeding tube.

At the edge of St. Peter's Square, hundreds of people gathered early today, concerned about the fragile pope. A few knelt on the cobblestones to pray, others wrapped blankets around themselves as they kept vigil through the night.

"There's nothing we can do but pray. We're all upset," said Agriculture Minister Giovanni Alemanno, who was in the crowd.

There were reports that the pope received the sacrament for the sick and dying, formerly called the last rites. The sacrament is often misunderstood as signaling imminent death. It is performed, however, not only for patients at the point of death, but also for those who are very sick -- and it may be repeated.

The Rome daily La Repubblica reported Friday that the sacrament was administered by John Paul's closest aide, Polish Archbishop Stanislaw Dziwisz, who serves as his private secretary. Dziwisz had given the pontiff the same sacrament on Feb. 24 just before the pope underwent a tracheotomy to insert a tube in his throat at Gemelli Polyclinic, the newspaper said.

According to its account, John Paul had attended Mass Thursday morning in his private chapel, then did paperwork from an armchair. Abruptly, at 6:45 p.m., John Paul turned ghostly pale and his blood pressure plummeted, the newspaper said.

After antibiotics were administered, the Italian news agency Apcom reported without citing any sources, John Paul's condition was "stable." ANSA, another Italian news agency, said the pope "seems to showing a first positive reaction" to antibiotic therapy.

At the Gemelli hospital, an emergency room chief said there were no plans to admit John Paul "at the moment," ANSA reported.

While the pope's condition deteriorated suddenly, the Vatican medical staff appeared confident it could handle the crisis with the sophisticated medical equipment installed for the pontiff.

Keeping vigil

As the crowd gathered to keep vigil near the pope, police kept them off St. Peter's Square, forcing them to congregate at the edges of the giant plaza.

"I was in the car and I heard on the radio about the grave condition of the pope. I immediately thought I would come to St. Peter's," said Antonio Ceresa, a Roman.

As news of the pope's latest health crisis swept the world, the pontiff's spokesman, Joaquin Navarro-Valls, told The Associated Press by telephone that "the Holy Father today was struck by a high fever caused by a confirmed infection of the urinary tract."

The pontiff was started on "an appropriate" course of antibiotics, Navarro-Valls said. "The medical situation is being strictly controlled by the Vatican medical team that is taking care of him."

Lights in the papal apartment above St. Peter's Square were on until about 11 p.m. Thursday, generally well past the papal bedtime. The light remained on in the Apostolic Palace's nursing station on the same floor as the pope's apartment.

Drop in blood pressure

A urinary infection can produce fever and a drop in blood pressure as reported in the pope, said Dr. Marc Siegel, a specialist in internal medicine at the New York University Medical Center.

The pope's risk of such an infection is heightened because of his age -- which suggests his prostate is probably enlarged -- debilitated and run down from the illness that recently sent him to the hospital, Siegel said.

Urinary infections tend to respond well to antibiotics, and "I would suspect there's a very good chance he's going to recover well," Siegel said.

Other physicians offered far more guarded assessments, given the pope's overall condition.

"His body has come to a standstill," said Dr. Zab Mosenifar, who treats elderly patients at the intensive care unit at Cedars-Sinai Medical Center in Los Angeles. "Usually, these people go in a downhill course."

Mosenifar noted that the body's organs are interdependent on one another and if one system fails, it could cause a "cascade effect" of other systems shutting down.

Dr. Benjamin Ansell, an internist at UCLA School of Medicine, said a healthy person may recover from a high fever with no problem, but it could be devastating for those with neurological disorders such as Parkinson's disease, which the pope has suffered for at least a decade. Some Parkinson's patients who develop a fever may turn catatonic, Ansell said.

"It's not a very promising situation," Ansell said.

Hospitalized twice last month following two breathing crises and with a tube placed in his throat to help him breathe, John Paul has become a picture of suffering. When he appeared at his apartment window Wednesday to bless pilgrims in St. Peter's Square, he managed to utter only a rasp.

Later that day, the Vatican announced he had been fitted with a feeding tube in his nose to help boost his nutritional intake.

The use of the feeding tube illustrates a key point of Roman Catholic policy John Paul has proclaimed: It is morally necessary to give patients food and water, no matter their condition.

As Parkinson's disease and other ailments have left him increasingly frail, the pope has been emphasizing that the chronically ill, "prisoners of their condition ... retain their human dignity in all its fullness."

The Vatican's attitude to the chronically ill has been apparent in its bitter condemnation of a judge's order two weeks ago to remove a feeding tube from Terri Schiavo, the severely brain-damaged American woman who died Thursday.

Vatican Cardinal Jose Saraiva Martins, reacting to Schiavo's death, denounced the removal of her feeding tube as "an attack against God."

Although different, some see parallels in the two cases.

Under John Paul, Vatican teaching on the final stages of life includes a firm rejection of euthanasia, insistence on treatments that help people bear ailments with dignity and encouragement of research to enhance and prolong life.

A 1980 Vatican document makes the distinction between "proportionate" and "disproportionate" means of prolonging life. While it gives room for refusal of some forms of aggressive medical intervention for terminally ill patients, it insists that "normal care" must not be interrupted.

John Paul set down exactly what that meant in a speech last year to an international conference on treatments for patients in a so-called persistent vegetative state.

"I should like particularly to underline how the administration of water and food, even when provided by artificial means, always represents a natural means of preserving life, not a medical act. Its use, furthermore, should be considered, in principle, ordinary and proportionate, and as such morally obligatory."

John Paul's 26-year papacy has been marked by its call to value the aged and to respect the sick, subjects the pope has turned to as he battles Parkinson's disease and crippling knee and hip ailments.

It is not clear who would be empowered to make medical decisions for an unconscious pope. The pope has no close relatives, but the Vatican has officially declined to comment whether John Paul has left written instructions.


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