Pope John Paul II (search) munched on cookies Friday and jotted messages to an aide about his condition as he recovered from surgery to ease another breathing crisis.
The Vatican took pains to emphasize the positive: the 84-year-old pope was breathing on his own, showed no signs of pneumonia and ate a breakfast that included coffee with milk, yogurt and 10 small cookies.
But other descriptions were impossible to ignore: John Paul fitted with a tube to ease his breathing and following doctors' orders to avoid speaking, at least for several days.
Each detail of his condition was shadowed by uncertainty, including how long the tracheotomy (search) device would remain and if the pope would regain full command of his voice. No official health update was expected until Monday.
The pontiff's rush by ambulance Thursday to Rome's Gemelli Polyclinic hospital (search) — a replay of a breathing crisis earlier this month — crushed hopes he was out of danger. Just a day earlier, he made his longest public appearance — 30 minutes — since returning to the Vatican from the hospital Feb. 10.
Surgeons cut a small breathing hole in the pope's throat to bypass suspected obstructions and insert the tube. The most common uses for a tracheotomy are to ensure that better quality air reaches the lungs and as a device for removing mucus, which can foster bacteria.
"It was a question of assuring adequate breathing of the patient. ... He (the pope) has a significant feeling of relief," said papal spokesman Joaquin Navarro-Valls. He denied reports that John Paul was placed on a "mechanical" respirator.
"He's breathing on his own," Navarro-Valls said, and there were no signs of fever or pneumonia.
The next major health decision could involve the tracheotomy tube.
In some patients the tube is left permanently, requiring significant changes in speech. Some people learn to talk through the tube. Another option is to briefly plug it — akin to holding your breath — and speak in short bursts. Either choice would be complicated by the pope's Parkinson's disease, which causes hand tremors and difficulties in coordination and muscle control.
For the moment, John Paul's only means of expression is the written word.
After the operation, he wrote a note to aides saying, "What did they do to me?" Navarro-Valls said, describing it as a joking message.
"I am always `totus tuus'" — the pope's motto in Latin that Navarro-Valls translated as "I am completely in your hands."
The image drove home a clear Vatican worry: that the pope's ailments gradually reduce his abilities to communicate — a hallmark of his 28-year papacy that's included 104 international trips and several best-selling books.
"This is a big problem," said Vatican Cardinal Renato Martino, mentioning the pope's temporary inability to speak. "He will find other ways to communicate, that we know already."
But John Paul's health troubles will likely amplify debate among the world's 1 billion Roman Catholics on a possible resignation — which is something the pope has rejected as he draws comparisons between his suffering and essential elements of Christian faith, such as the Crucifixion of Jesus Christ.
Earlier this month, the Vatican's No. 2, Cardinal Angelo Sodano, declined to rule out the possibility of resignation and said it was "up to the pope's conscience."
This could become a crucial point, some theologians and Vatican observers say. The pope's concern for the church could eventually conflict with his diminished abilities.
"Modern medicine can keep someone alive long after they can really function in this world. At the same time, the papacy has grown in importance," said the Rev. Thomas Reese, the author of a book on Vatican practices.
"Right now, he says he won't resign. But, on the other hand, if a doctor tells him, `You are going to be bedridden for the next five years and we can keep you alive but not really anything more,' then the pope could reach another decision."
Around the world, vigils and special Masses were held for the pope. The concern spread well beyond Catholics — a sign of how John Paul transformed the papacy into a global institution whose messages can cross faiths.
Rome's chief rabbi, Riccardo Di Segni, traveled to Gemelli for a personal update by the pope's doctors. The city's Muslim leaders also expressed hope for the pope's recovery during Friday prayers.
Dr. Corrado Manni, the pope's former anesthesiologist, told the newspaper La Stampa that John Paul should have "definitely" remained hospitalized longer after his first crisis, but added that the pope was a "difficult" patient after the 1981 attempt on his life.
"He told me: 'The pope is either well, and then he must leave, or he is not well, and then he must stay.' I answered him: 'Your Holiness, there is a state of illness and of well-being, but in the middle there is a third state, that of convalescence.' Words spoken to the wind. I understand the difficulties his aides must have in dealing with such a situation. The Holy Father is difficult."