Pope John Paul II's latest hospitalization has pushed his papacy into a new phase, with aides and top Vatican officials speaking in his name, celebrating Masses for him and representing the frail pontiff at church functions.
While officials take pains to say the 84-year-old pope remains engaged in key church affairs, they also acknowledge the uncertainties that lie ahead — ranging from his ability to participate in Easter events at the end of the month to longer-term questions about whether he can speak.
"This is what we don't know: how he will be in the future, whether he will be able to speak or not," said British Cardinal Cormac Murphy-O'Connor.
Vatican officials stress the church machinery rolls on. Just this week, John Paul appointed a bishop in Brazil, a top Vatican cardinal attended a conference on Catholic-Jewish relations in New York and a papal diplomat addressed a European conference in Hungary on regional autonomy.
Belgian Cardinal Godfried Danneels, speaking in New York, said John Paul "has very clear lucid judgment for the moment. I spoke with him a few weeks ago. He had difficulties in answering but he had a clear mind."
Another cardinal, Joseph Ratzinger, visited John Paul at the hospital Tuesday to discuss Vatican business.
"The pope spoke with me in German and in Italian," said Ratzinger, a German who runs a powerful Vatican office that deals with issues of Roman Catholic doctrine. "I am happy to say that the Holy Father is fully alert mentally and also able to say the essential things with his voice."
But John Paul now uses an Argentine archbishop from the secretary of state's office, Leonardo Sandri, as his official voice for the public.
Since celebrations at the Vatican marking John Paul's 25th anniversary as pope in 2003, the pontiff has been handing over many of his speeches to aides, after reading brief selected parts, because of speaking troubles related to Parkinson's disease. Last Sunday, Sandri read the entire text from the steps of St. Peter's Basilica just before John Paul made a one-minute silent appearance at the 10th floor window of his hospital suite.
John Paul "spoke with his eyes," the Vatican newspaper L'Osservatore Romano said.
The twilight years of several recent papacies — a post without term limits and from which resignation is rare — have been marked by illness.
Except for the funeral of slain Italian politician Aldo Moro, when Pope Paul VI was carried in by aides, that pontiff was rarely seen in public in the months before his death in 1978.
John-Peter Pham, a church expert who worked at the Vatican in the 1990s, drew parallels between John Paul's decline and the last years of World War II-era Pope Pius XII, who was frequently seriously ill, including suffering intractable hiccups, before his death in 1958.
Pius started suffering major health problems in 1952, "but the physicians were able to keep him alive for six more years," Pham said.
Lying ahead for John Paul is the Easter holiday, the most solemn on the Christian calendar. He has been steadily reducing his participation in a Way of the Cross Procession at the Colosseum on Good Friday, but has continued to preside at a three-hour Easter vigil and a Mass on Easter Sunday, which falls this year on March 27.
There is also the question of audiences with world leaders, important for the head of a church with 1 billion members and considerable political clout in Catholic countries.
Since he was rushed to the hospital with breathing difficulties Feb. 1, John Paul has missed meetings with Secretary of State Condoleezza Rice, the president of the European Parliament and the president of Azerbaijan.
While no meetings have been announced, Vatican officials expect that the new Ukrainian president will visit the Vatican in the spring. It would be an opportunity for the pope to reach out further to Orthodox Christians and underline how the Catholic Church in Ukraine supported democratic elections.
Further down the road is the church's World Youth Day in mid-August in Germany, a favorite papal appointment and the only foreign trip on his schedule this year.
The trip is still officially on, and a German cardinal said Wednesday the pope would bring a powerful spiritual presence even if he couldn't speak.
Cardinal Joachim Meisner of Cologne told reporters after meeting with John Paul in his room at Rome's Gemelli Polyclinic hospital that the pontiff greeted him, saying: "I'm happy to see you here."
"It's not important that the pope speak with the many, many young people, but it's his presence that's important," the cardinal said. "The person of the Holy Father speaks a lot."