Osservatore Romano via AP
In this photo, made available by the Vatican newspaper Osservatore Romano, Pope John Paul II looks at a televised transmission from St. Peter’s Square from his hospital room at Gemelli Polyclinic hospital in Rome on Sunday.
By NBC News Producer
NBC News
updated 2/28/2005 1:33:19 PM ET 2005-02-28T18:33:19

Sunday morning Pope John Paul II made a surprise appearance at his hospital window, giving an unexpected proof of life that went around the world in a matter of minutes.

The window was kept closed, and he didn’t say anything, but he looked like his “old self,” waved twice and made the sign of the cross, bringing emotional cheers from the crowd below.

Twenty-four hours later, on Monday, the Vatican released its first official “medical bulletin” since last week. The few short statements emphasized the positive aspects of his recovery — the pope is “eating regularly, his general condition is good,” and he’s spending some hours in an armchair. 

But it’s the last phrase that captured the uncertainty of what lies ahead for this papacy: “The Holy Father has begun exercises to rehabilitate his breathing and phonation.”  The Oxford dictionary definition of “phonation” is the “production of speech sounds."  

That means the pope is now learning how to speak with a tube in his throat.

Speech problems aggravated
The implication here is that the tracheotomy may not be as temporary as Vatican spokesman Joaquin Navarro-Valls had described it in his initial post-op briefing.

Some medical experts talking to NBC News have also said they don’t think the tracheotomy will be reversed because the pope’s respiratory system, severely taxed by late-stage Parkinson’s disease, is at high risk for the bacterial pneumonia that is often fatal for the elderly.

Slideshow: A historic papacy

John Paul has been having trouble speaking for the last couple of years. The most noticeable symptom of Parkinson’s disease, other than his constantly trembling left hand, has been the freezing up of facial muscles that give him a “stony-faced” look, preventing him from smiling and expressing normal emotion. 

This stiffening of the features also affects the movements of his lips and mouth, making his speech slurred and difficult to understand. Because of this problem, the bulk of his speeches have been read by aides, leaving the introductory and concluding comments to the pope.

In the past year, however, the speech impairments have been aggravated by a seeming lack of air in his lungs. His breathing became more and more labored, and he needed to pause for breath every few words.

On Feb. 1 things got much worse in a hurry. The pope had appeared at his customary Vatican window two days earlier for the Sunday blessing with a terribly raspy voice, and he sounded sick. His condition raised the eyebrows of most pope-watchers, but the worry was quickly counterbalanced by the good cheer with which he tried to release two white doves in a symbol of peace with some Roman children alongside him.

That afternoon, however, John Paul suffered spasms of the larynx, a choking sensation that is apparently terrifying for the patient, described as “feeling like dying.”  He was rushed to the hospital, where his condition was stabilized, and doctors said breathing tubes were not necessary and characterized the symptoms as complications of the flu.

Ten days later the pope was released from the hospital. The flu was pronounced cured. Episodes of laryngo-tracheitis had not reoccurred. But it turned out the doctors had spoken too soon.

The wave,  smile and blessing may have to do
Last Thursday, two weeks to the day after the pope had left Gemelli hospital, he was rushed back and given an “elective tracheotomy.”

The silent pontiff who appeared at the window on Sunday might be the new face of this record-breaking papacy. With all the hope that speech therapy will enable John Paul to communicate once again, the foreseeable future promises a papacy “on mute.”

For now, Pope John Paul II can’t walk and can’t talk, but he can still wave, smile and extend the gesture of a blessing.  For now, that will have to do.

Stephen Weeke is the NBC News' Rome bureau chief.

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