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Pope Undergoes Tracheotomy

Aired February 24, 2005 - 15:28   ET


KYRA PHILLIPS, CNN ANCHOR: I want to bring in my cohort Judy Woodruff live out of Washington, as we continue our breaking news coverage -- Judy.

Kyra has just summed it up. CNN is following the breaking developments surrounding the health of his holiness, Pope John Paul II. And, as Kyra has been telling you, the pope is back in the hospital. He was in earlier in the month of February, came back to the Vatican. It was believed he was doing better. And then, overnight, his health took a turn for the worse.

It was a little before 5:00 a.m. Eastern time, a little before 11:00 a.m. in Rome when the pope was taken to the hospital again today for trouble breathing, respiratory problems.

Let's bring back our Jim Bittermann, who is standing by outside the Gemelli Polyclinic Hospital in Rome.

Jim, what is -- what are you hearing from authorities at the hospital?

JIM BITTERMANN, CNN CORRESPONDENT: Well, absolutely nothing from the authorities at the hospital. Like the last time the pope was here, the hospital will not say anything without direction from the Vatican.

Now, what we are hearing from the Vatican is that it's plausible that the pope would undergo some kind of operation. They're not confirming or denying either way. This report has been out for about an hour now on Italian media, that, in fact, the pope might go through some kind of an operation and tracheotomy perhaps.

And -- but there is no confirmation at all, and nor do I really expect much confirmation, until perhaps, if there is an operation, until perhaps the operation is over. It strikes me as the kind of thing the Vatican would probably not want to say anything about. If it was still upcoming, then they would probably want to only confirm it once that it had taken place.

Now, the other thing that I just should say that is happening here, and it may be nothing, but there is some sense on the ground, some preparation that perhaps somebody is coming here to visit the pope. The police, the Caribinieri, have been deployed a little bit, and some of the media crews are out. So there is a possibility that maybe someone coming here to visit the pope. As far as we know, Renaldo Buzinetti (ph), the doctor -- the pope's doctor, is still inside. He came to the hospital with the pope this morning at 10:45 Rome time and has been in the -- has been in the hospital ever since.

And that's another thing that we're kind of looking for. If he were to leave the hospital, I think that would probably be a sign that things are going fairly well for the pope. The fact that he's staying inside may, in fact, be some sort of confirmation that there is more planned for the pope this evening, potentially in the way of perhaps an operation -- Judy.

WOODRUFF: Jim, if the Vatican is saying very little, how is the Italian media getting its information?

BITTERMANN: Well, I think the Italian media are happy to report things that sometimes don't turn out to be the truth. I guess that would be the most polite way to put it.

The fact is that there is really no confirmation, without Vatican confirmation, on any of this. The doctors may say things for one reason or another, nurses may say things, but whether they reflect the truth is another story.

So it's not the kind of thing that I think CNN could get into the position of reporting. But when we do have confirmation of the operation or anything else, we'll, of course, pass it along -- Judy.

WOODRUFF: So, Jim, just to recap, what we absolutely know for certain is that the pope, his holiness, is back in the hospital. And what have they said exactly what about what he's undergoing, what treatment, his condition?

BITTERMANN: They said he's had a relapse of the flu that he suffered several weeks ago, with complications. And that, of course, has led to a lot of speculation as well. So that's exactly what the Vatican has said, a relapse, flu symptoms, and with complications -- Judy.

WOODRUFF: OK. Jim Bittermann reporting from Rome just outside the Gemelli Polyclinic Hospital where the pope is being treated right now.

I want to quickly bring in CNN's medical analyst in all stories that are health and medical related, Dr. Sanjay Gupta.

Sanjay, we just heard Jim underline that we don't know for sure that a tracheotomy is planned, but there is a lot of speculation in that direction. What would that mean about the pope's condition if that were to be the case?

DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: It is certainly a serious procedure. Nobody takes that operation lightly.

While it is a simple procedure, it will be a significant change in what we've been hearing for so long about the pope. A couple of things, Judy. When someone comes to the hospital with some sort of breathing difficulty, goal number one for any doctor is to try and secure the airway. What is a little bit confusing here, Judy, is that typically the way that is done is by actually placing a tube from the mouth into the trachea.

You can see the diagram there. That's actually looking at the -- from the side of somebody's head. And typically the tube is actually placed from the mouth into the airway.

If that can't be done -- and we're not saying that in this case -- but if that can't be done, then a tube is actually put straight into the trachea. Let me show you. I've got a -- I've got a model here as well.

Again, if the tube is going to be put normally, it goes from the mouth down into the airway. With the tracheotomy, we're talking about an operation, Judy, actually making an incision in the neck and then placing the tracheotomy straight from the neck into the airway.

Why is this being considered as a sort of first procedure? Unclear at this time.

What we do know is that the pope had significant spasm of his airway previously. He also has Parkinson's Disease, which may make it difficult to actually place the tube from his mouth into the airway. And, you know, this question about the flu and how significant that is.

If he has the procedure done, he won't be able to speak, certainly not while the actual device is in his neck. And it's going to, again, require an operation with general anesthesia.

WOODRUFF: And how long does a procedure like that take, Sanjay?

GUPTA: It's a very common operation. Typically, it doesn't take more than half an hour to an hour or so. Most doctors will tell you, Judy, that it's not the operation itself that is of most concern, but, rather, the anesthesia.

Putting an 84-year-old person with significant medical history under general anesthesia is not something that doctors take lightly. That is a bigger risk, a bigger concern than the operation itself.

WOODRUFF: And, Sanjay, the statement that Jim Bitterman said that the Vatican put out very spare, that he's had a relapse -- the pope has had a relapse with complications, does that tell you anything? Or do does that leave it wide open?

GUPTA: Yes, it does actually tell us a fair amount of information. And here is what we can tell you, is that, first of all, it's not uncommon for a person who is 84 years old with medical problems to have a relapse of the flu-like symptoms: coughing, breathing, difficulty with his airway, all those sorts of things.

A couple of things, Judy. The Vatican itself, as you know, has a pretty significant medical facility. So the fact that they decided to take the pope for a second time now to a hospital sort of raises our antennas a bit medically.

What is it that he is going to be getting at the hospital versus at the Vatican itself? Also, when you talk about the complications of flu, we spend so much time talking about the flu and how serious it can be. Most healthy people get over the flu just fine. But in the United States, tens of thousands of people die from the flu.

Who are those people? Those are people who are typically elderly and people who have existing medical conditions, just like the pope does. So even a simple cold, what people will call a simple flu, even, is not to be taken lightly in the case of the pope.

WOODRUFF: And Sanjay, one other question. The fact that the pope has Parkinson's, how would that affect his condition and the treatment of the condition?

GUPTA: Excellent question and point, because people think of Parkinson's typically having some tremor, having some rigidity of muscles. In the case of Parkinson's, it can also affect muscles in the upper airway.

We've been talking about this now. So if the pull muscles in the upper airway are constricted a bit because of the Parkinson's, on top of that he's having spasms, on top of that he's having these flu-like symptoms, all of a sudden you get into a situation where you might have some concern about being able to secure his airway. And that is probably what doctors are working on and are thinking about, at least right now.

WOODRUFF: OK. CNN medical correspondent Dr. Sanjay Gupta. And I know, Sanjay, we're going to be coming back to you often in the moments and the hours to come. Sanjay joining us from Atlanta.

With me here in Washington is Robert Moynihan. He's the founder of the monthly magazine "Inside the Vatican." In fact, Delia Gallagher, who we've just been talking with, CNN analyst, works with you -- worked for you, in fact, at the magazine.

Robert Moynihan, you cover, you know the Vatican. You know the Catholic Church very well. What are you sensing and hearing from all this reporting?

ROBERT MOYNIHAN, "INSIDE THE VATICAN": There are two contradictory things. First, that the pope has been active and stubborn. And Delia made that point.

He, himself, in the last 10 days, was trying to recover his schedule and pick things up, again, against the advice of his doctors. So that describes a man who is fairly healthy.

But to bring him back to the hospital a second time, I've heard that the muscles in his upper chest and throat are very rigid, which is just what the doctor was saying. And people are saying this morning they were thinking it's not serious. But this evening, they're quite worried.

WOODRUFF: What is worrying them?

MOYNIHAN: That he's very weak, that some complication could further emerge. He's having difficulty breathing to the point they are considering this tracheotomy.

We don't even know for sure that they're going to do it. And if they do it, the anesthesia, the complications from that, the flu has evidently caused swelling in his throat. So he's having difficulty getting air in and out of his lungs.

WOODRUFF: How much more do you think is there to know about the pope's condition than we are being given?

MOYNIHAN: We won't get the entire story, but we will get a bulletin tomorrow at noon. Officially, we don't know much.

WOODRUFF: And I just want to break in, Robert, Moynihan. I'm told that Italian news agencies are now reporting -- this is not from the Vatican. This is Italian news agencies are reporting that the operation, a tracheotomy has now been performed on his holiness, Pope John Paul II.

Let's go quickly back to our correspondent at Gemelli hospital.

Jim, tell me what the Italian news media are saying.

Apologies. We're not able to hear what Jim is saying, or maybe he can't hear us.

Very quickly back to you, Dr. Sanjay Gupta, CNN medical correspondent. So the fact the tracheotomy has taken place, Sanjay, tells you what?

GUPTA: Not surprising at all, Judy. This is not a procedure that is done electively, not the sort of thing you sort of schedule a week from now.

If you determine that someone needs to have his airway secured, this is something you do rather urgently. Again, this is goal number one for the pope, for anybody who comes to the hospital, making sure they have an airway and that they can breathe well.

Again, I guess it's good to know the procedure has been done, it's more important to know how he's doing after the operation. The biggest concern, as you and I were talking about, Judy, before, was the anesthesia. Unclear how long it will take for him to wake up and sort of regain his faculties about him.

WOODRUFF: Sanjay, I want to -- I want to be clear here. We don't know -- there's been no confirmation from the Vatican. It is coming from Italian news agencies that the tracheotomy was performed.

They are saying it was a 30-minute procedure, it has now been done, they are reporting. But, again, we have no confirmation of this from the Vatican. So we have to keep saying this is what's been reported. And, of course, we'll wait for hard information to come out of the Vatican.

OK. Now, Sanjay, stand by, because now I'm told that Jim Bitterman is with us.

We can hear you, Jim. Tell us what you're hearing there.

BITTERMANN: I hope so, Judy. In any case, yes, what we're hearing about is what you're hearing, and that is that the Italian news agency, one of the leading Italian news agencies, is reporting that the pope has been undergoing an operation, past tense, that the pope has been operated on, that the operation took about 30 minutes.

No confirmation at all from the Vatican one way or the other, except that, as we had reported earlier and was said earlier from the Vatican, that, in fact, it's plausible that the pope would have had some kind of operation given the kind of breathing problems he's had. So, again, it's attributed to a Italian news agency, but basically saying that the pope was on the operating table for about 30 minutes for this operation. Still no confirmation of what kind of operation, although the suggestion is that it was a tracheotomy to help out his breathing problems -- Judy.

WOODRUFF: And Jim, I'm also told that the Italian media are saying that the Vatican -- that there will be an official statement about the pope's condition coming in the next few minutes. Of course, we're all looking for that right now. The Italian media, where do they get their information again?

BITTERMANN: Well, I think they probably have various sources. And we're not very trusting of the Italian meeting because we've been let down in the past numerous times before.

I think that it really is something that we have to regard with skepticism until we can confirm it one way or the other. And as I mentioned before, the information is really being very tightly controlled by the Vatican.

I mean, one thing you should remember and our listeners should remember is that everybody around the pope depends on him for their jobs. And when the pope does have difficulty, the pope would resign or were to die, the fact is that they would instantly lose their jobs. And so they have a great deal of vested interest in making sure the pope continues as long as possible, and at least making it sound as if the pope is in as good condition as possible.

So it's one of the reasons why we have such difficulty getting information out of the Vatican, or at least information that we can depend on -- Judy.

WOODRUFF: Sure. Like every institution, the interest is in having everything as stable and predictable as possible.

I do have a question for Sanjay Gupta. Is -- Sanjay, are you still there on the set? GUPTA: Still here, Judy. Yes.

WOODRUFF: In Atlanta. What happens after a tracheotomy is done?

GUPTA: He, most likely, is going -- again, needs to wake up from the general anesthesia. Will probably be placed on a ventilator, which means being in an intensive care unit.

The reason being that the ventilator will actually provide breath for the pope while he is still waking up from general anesthesia. And he may need to be on the ventilator for sometime after that as well.

Again, the purpose of a tracheotomy is to make sure that the airway is secure. They may also do what we call some pulmonary cleaning as well, Judy, actually suctioning his lungs to some extent in case he is developing an early pneumonia to try and ward that off as well. Probably in the ICU at least for several days -- Judy.

WOODRUFF: OK. Sanjay, thank you very much.

And right now, I'm told Delia Gallagher has some new information. She's a CNN Vatican analyst in our Rome bureau.

Delia, what are you learning?

DELIA GALLAGHER, CNN VATICAN ANALYST: That's right, Judy. We can confirm from a Vatican official who's told CNN that the pope has had the operation.

So those are confirmed reports by the Italian news agencies. We've had a Vatican official tell CNN that the pope has indeed had the tracheotomy, and we will expect a news bulletin in the next few hours from the Vatican with the pope's state of health.

So that is an update from what we were expecting before, which was a bulletin noon tomorrow. So we'll have some news in the next few hours officially from the Vatican. But we do know that he has had the tracheotomy. He's undergone that -- Judy.

WOODRUFF: Delia, how is the Vatican communicating with reporters?

GALLAGHER: Well, of course, at the moment, we're deep into the night here. And it's all via phone because the Vatican is closed.

You know, you were talking earlier about how you get information at the Vatican, and one thing you've got to learn covering the Vatican is they don't give hourly updates. They give us a bulletin once a day at noon, and that's about the extent of it.

Now, in an extraordinary situation like this, we are in touch with the papal spokesperson, Joaquin Navarro-Valls, and we are in touch with our sources at the Vatican. But they have to understand whatever the prognosis is from the hospital. So it takes its time, but as far as the Vatican is concerned, is moving quickly.

WOODRUFF: So they are talking to the press by telephone. And what are they saying in terms of when we get the next piece of information or next update on the pope's condition?

GALLAGHER: Well, we will have the next official bulletin from the Vatican in the next few hours, we have been told. Now, of course, the pope's spokesman is at the hospital with the pope, as are presumably some of the other Vatican officials, and they are monitoring the situation from there.

We are in communication with them via phone and with our other sources. So we are monitoring the situation, but they will have to get together and come up with what exactly the prognosis is. And presumably, they've just done this operation. The doctors themselves will need some time to figure out what the situation is -- Judy.

WOODRUFF: OK. Delia Gallagher, CNN Vatican analyst. She also works with Robert Moynihan, who's here with me in the studio in Washington. He's the founder of the monthly magazine "Inside the Vatican." And also with us from Atlanta, Dr. Sanjay Gupta.

Robert Moynihan, I want to come back to you. You're hearing -- we're hearing how this information gets out. I find that important to the story right now, because there is such enormous interest in knowing the condition of the pope's health. Does all this sound the way you would expect at this point?

MOYNIHAN: About 15 years ago, an old Vatican journalist said to me, "When the pope dies, you will hear that he has got the flu, and then he'll be dead." I'm not saying this is occurring now, but the Vatican is known for keeping everything under wraps and then suddenly announcing it.

One thing we can know. They have two large doors, the right side of St. Peter's Square, the (UNINTELLIGIBLE). If one of them is closed, the pope is dead, even before an announcement is made. We have people watching those doors.

I also think that the pope could recover fully. And we're sort of on a watch here, and partly the lack of information is causing perhaps more speculation than there otherwise might be. So there should be an announcement in an hour or two that the pope has had this operation, and then we'll wait to see how he's doing.

WOODRUFF: You spoke a moment ago, Robert Moynihan, about how the pope was trying to make a comeback in the last few days when he was back working at the Vatican.


WOODRUFF: But given the fragility of his health, and now given these circumstances, who is running the Catholic Church? Who's running the Vatican?

MOYNIHAN: Well, the Vatican is a large place. There is 1,500 people who work there. The pope is given directives to all of his chief people, and a lot of things run on their own. He's got all the various offices, just like our government has.

If there is a major question, they'll postpone it. He would still be deciding major questions even now. So they'll postpone a decision.

WOODRUFF: So even assuming he stays in the hospital for a period of -- we don't know, but if it were hours, days, or longer...

MOYNIHAN: We start to create a scenario of a kind of a crisis which probably doesn't have a precedent. We've had popes in the past who have been very ill. Pope Pius XII was quite ill the last four years of his life.

In this case, it's unclear how incapacitated the pope will be, if he even can indicate things. He seems to still have a very clear mind. What he seems to have is a physical problem that's blocking his breathing, and that's causing him a lot of trouble.

WOODRUFF: So what we can say for sure at this point is that it's been now confirmed the tracheotomy on the pope has taken place. All right. Robert Moynihan, we're going to have you stand by, Sanjay Gupta in Atlanta.

And now I want to go back to my colleague Kyra Phillips in Atlanta.

Kyra, still, we got a little more information than when you and I last spoke, but still many questions.

KYRA PHILLIPS, CNN ANCHOR: Absolutely, Judy. Thank you so much. We want to once again welcome our international viewers and our domestic viewers right now as we continue to follow the progress of Pope John Paul II.

We can tell you now it has been confirmed that the pope did undergo a tracheotomy. He underwent that surgery just about an hour ago. It took about 30 minutes.

What we can tell you is that the pope had been suffering -- had some respiratory problems back in January. He was suffering from the flu. He was checked into the hospital there at Gemelli. You're looking at a live picture right now, February 1.

He was in there for nine days. He was released after 13 days, made a couple of public appearances. Seemed to be recovering and was in fairly good condition.

Then we got word today that he was admitted back to Gemelli Hospital with more respiratory problems. Our Dr. Sanjay Gupta telling us that when you have a tracheotomy, it's something usually that's decided on an emergency basis. And, of course, as you know, the pope has been suffering from Parkinson's Disease, and that could have led to the complications with regard to his breathing.

Just outside of Gemelli Hospital, CNN's Jim Bittermann has been following the pope's condition for us.

Jim, it looks like we have been able to confirm, Delia Gallagher out of our Rome bureau said she did get word the pope had a tracheotomy. What are you hearing just outside of the hospital there at Gemelli?

BITTERMANN: Well, certainly nothing that would contradict that. The fact is that, as we understand, he did have this tracheotomy. The operation took about a half-hour, and that he's now in the post- operation phase.

You know, Judy was talking a little bit ago about the ability to get information out of the Vatican. Back in 1978 -- and I was here back then when Paul VI was dying -- we didn't know that he was dying at all. In fact, we didn't know he was suffering from stomach cancer.

The Vatican just occasionally would put out an announcement saying the pope would cancel this or cancel that because he was having stomach problems. And then on the Sunday that he actually died, the angelus was canceled. The Vatican said that again he had an upset stomach and he wasn't going to be able to do the angelus, and nine hours later, it was announced that he was dead.

So it is a very difficult place to cover, the Vatican. It doesn't always work the way democracies work. It's not necessarily a very democratic place. It's an absolutely monarchy, after all, and information is very tightly held. So we may not get all of the details about what the pope's condition is for some time yet -- Kyra.

PHILLIPS: All right. Jim Bittermann there, just outside of Gemelli Hospital. We'll continue to check in with you. Thank you so much.

We want to come back here to Atlanta, Dr. Sanjay Gupta.

Well, we were talking about the tracheotomy. You said if, indeed, it took place, it would take about 30 minutes. We'll we're now being told it did take place, it took 30 minutes.


PHILLIPS: Let's talk about what the pope is going through right now if, indeed, this was successful. Because we are getting word, according to Reuters News Service, that the operation was a success.

GUPTA: A couple of things have changed now. Now that we've confirmed that, in fact, he had the tracheotomy, I think we can safely say that this wasn't just the flu. He's probably had some inflammation, significant inflammation of his upper airway as well. I think that's a pretty safe assumption now.

What is probably happening with the pope is that he's probably either in the process of being transferred from the operating room to the ICU, intensive care unit, or is already there at this time. The reason for that is he'll probably be connected with a ventilator.

This is a machine that provides breaths and takes over the breathing for the pope, at least while he's waking up from the anesthesia. It's unclear at this time. We certainly have no way of knowing how long he will need to be in the intensive care unit, how long he'll need to be on the ventilator. We can tell you this, though, that after he wakes up, he won't be able to speak. You can't speak when you have one of these tracheotomy devices in. He still may be able to communicate in other ways by writing, gestures, whatnot. But it's going to be -- it's going to be a long road. A lot of things have changed for him after this procedure.

PHILLIPS: All right, let's -- you have a model next to you. Let's talk again about this surgery, what the pope went through for 30 minutes. Really, you said actually the major part of that surgery is the anesthesia, not so much the procedure.

GUPTA: That's right. I mean, this is an operation performed at just about every hospital in the world.

Now, when it comes to these sorts of procedures, it's not so much the operation itself, but the anesthesia that's of concern. The operation typically involves making an incision in the neck up, up and down here, and then actually finding the trachea, which is just behind -- just underneath the skin there. You'll find that, and actually making an incision in the trachea, and subsequently placing a tube directly into the airway, which then goes down into the airway a certain -- a certain depth.

Now, again, a common operation. Worry about the anesthesia. The operation absolutely mandatory, though, for someone who does not have a secure airway, who is having difficulty breathing and cannot have a tube placed from the mouth.

PHILLIPS: Now, considering that he also has Parkinson's Disease, OK, how does that affect what he just went through and his recovery, and how well he's going to be able to communicate and function after the surgery?

GUPTA: OK. A couple of things to keep in mind. Whenever someone has Parkinson's, the anesthesiologist is probably thinking about the best way to use general anesthesia and the best way to allow the pope to wake up from the general anesthesia as well.

Parkinson's Disease certainly can be a significant disease with regards to some of those things. Also, we've been talking so much about the fact as to why he needed this tracheotomy in the first place. Difficult to say for sure. But Parkinson's may have played a role in that as well.

While many people think of Parkinson's simply as the tremor and rigidity of muscles, it can also impair other things, including some of the muscles in the upper airway, making it difficult for him to breathe. Now, it's unclear again if any of that is actually what prompted the tracheotomy in the first place, but the fact that he has Parkinson's is probably going to make his convalescence a little bit longer, the medication choices a little bit different.

PHILLIPS: OK. And the tracheotomy, we know he was suffering from the flu, he was having respiratory problems. After having this procedure, will this help prevent, say, the respiratory problems, the flu from getting worse, say, pneumonia or something else that could be a little more detrimental?

GUPTA: I think so. And it's an important point.

When you do a tracheotomy and you decide to do this operation, it is for a longer-term thing. No one knows that the tracheotomy will be permanent, but we're talking about leaving the device in for sometime not only to secure the airway, but to allow doctors to do something they call pulmonary cleaning, actually cleaning the lungs.

If he has an infection in the lungs, if he develops an infection in the lungs, the tracheotomy will actually help facilitate him recovering from that more quickly. So those could all be benefits to the tracheotomy.

Again, the information has been so sparse out of the Vatican. All we know is that he was admitted with some relapse of flu-like symptoms. Some complications of the flu could be a pneumonia, could be bronchitis, could be some of these other things, but none of that has been confirmed right now.

PHILLIPS: OK. Dr. Sanjay Gupta here in Atlanta, following the tracheotomy that took place not long ago on Pope John Paul II.

We can tell you that according to Reuters News Service, it is reporting that the operation was a success, that Pope John Paul II did undergo a tracheotomy after being checked into the hospital for the second time within the past few weeks, after suffering respiratory problems from the flu. He was checked into the hospital back in February. He was in there for nine days, then released. He went back in today for the surgery that we are being told, according to Reuters, the operation was a success.

Delia Gallagher, CNN Vatican analyst, joining us once again live from our Rome bureau.

You brought us the news confirming that indeed he did have the tracheotomy. Have you learned anything else since we last talked, Delia?

GALLAGHER: Well, what we have heard is that the pope spokesman, Joaquin Navarro-Valls, has reported to the Italian press and picked up again by Reuters that the surgery was a success. So we can assume that for the pope this part is over.

But, of course, the thing to look for, as Dr. Gupta was saying, is once he comes out of the anesthesia and what they're going to do in the next few weeks, Kyra. This is really going to be a key point for the pope, because with this tracheotomy, we have to see how that is going to affect his voice, assuming that physically he's going to be able to come out of it OK, as he did before his last hospital visit. But this time, it's a little bit more severe.

It's going to take a longer time. And we have to see how that's going to affect his voice. It's one of the last things he's got there is a little bit of that voice left. And he's not going to be happy if he's not able to use it -- Kyra. PHILLIPS: You make a good point, because I believe it was yesterday, wasn't it, on closed circuit television, that he -- you did hear his voice. It sounded a bit grave, but he was animated. He did address his followers.

So you're right. It seems like no matter what he goes through and what he encounters, he just -- he just does not give up and he wants to keep pushing forward.

GALLAGHER: Well, and this is really the surprising thing about this tracheotomy today. When he came out of the hospital two weeks ago, he had a few days of rest and then we saw him on Sunday at the angelus, and then we saw him again on Wednesday, we saw him again on Sunday.

We saw him several times. And all of those times, his voice was, for the pope, good. It was strong.

He was gesticulating with his hands, he was clear, and in a very loud clear voice spoke to people. And yesterday, he spoke for a good half an hour on and off. So it was very surprising this sudden downturn.

But, as you say, the voice is something that the pope really relies on at this stage even though it's quite slow and belabored. So he's going to have to work back up to that in the coming weeks -- Kyra.

PHILLIPS: And Delia, in addition to suffering from Parkinson's Disease, we know that the pope has had a number of chronic diseases, including his hip problem, his knee ailment. He's undergone nine operations since he's been pope, including the hip replacement. And, of course, he survived an assassination attempt.

Now, the pope, according to the Vatican, an operation that has been successful, his condition now regular, after undergoing a tracheotomy. With a man whose mission is about human suffering, creating compassion, he is living exactly what he has wanted to do within the past 26 years.

GALLAGHER: Yes. It's really incredible.

He, himself, says it. We were talking about the book earlier. You know, he says, hey, there's somebody helping me out here because I couldn't possibly do this and recuperate so many times on my own.

I mean, he believed it at the assassination attempt, that the Virgin Mary was watching out for him and guided that bullet so it didn't kill him. And I think that is his very firm belief. You cannot understand this pope without understanding that very mystical side of him.

He's a spiritual leader for millions of Catholics. And that is what he believes, that this is not his will, and it's not his recuperation, it's the will of god for him -- Kyra.

PHILLIPS: His spiritual influence is amazing. Delia Gallagher, our CNN Vatican analyst there live from Rome, thank you so much.

We also have CNN's Jim Bittermann outside of Gemelli Hospital. Our Dr. Sanjay Gupta is here in Atlanta. We've been following the progress, an operation now the Vatican is saying was a success after Pope John Paul II underwent a tracheotomy just within the past hour or so.

It took about 30 minutes, we are told. His condition right now, according to the Vatican, is regular. We want to go back to Judy Woodruff live in Washington as we continue to follow our breaking news coverage -- Judy.

WOODRUFF: Kyra, thanks and one other little piece of information we can share. Reuters is quoting the Vatican as saying that the pope will spend the night in his own hospital room, not in what they call intensive care. Now, what we don't know is the extent of equipment in that room. I understand Delia Gallagher, our Vatican correspondent analyst, has a little more information -- Delia.

GALLAGHER: Well, you know, one of the things up on the tenth floor there in the Gemelli, the reason that they take him there, Judy, is for the 24-hour care more than for the equipment. Of course, they can bring the apparatus to the Vatican, but at the Vatican, in his apartments, they're just not set up to have the nurses and doctors there 24 hours.

So that's really the main reason why they take him to the hospital, outside, of course, of doing the operation, which was what happened just a few hours ago. But taking him to the hospital, monitoring him there and keeping him there is really to give him that 24-hour care that the few nuns and the priests that are living with him in his apartments cannot provide -- Judy.

WOODRUFF: All right, Delia Gallagher pointing out that the pope getting more comprehensive medical care, staying in the hospital, even though we are just learning, Reuters reporting, that the Vatican is saying the pope will not spend the night in intensive care, he will be in his own hospital room. But, again, as Delia says, presumably more thorough, more comprehensive care than anything that would be available if you were to stay overnight at the Vatican.

Just to recap, it's just after 4:00 Eastern time here in the United States, just after 10:00 in the evening in Rome, where Pope John Paul was taken to the hospital earlier today. Trouble with his respiratory ability. We are told, the Vatican said, he had a relapse of symptoms, the flu-like symptoms with complications. And we've been trying ever since then to determine what that represents.

His Holiness did undergo a tracheotomy just within the last hour or so. We believe it was a 30-minute procedure. It is now ended. Dr. Sanjay Gupta, our medical correspondent, telling us that in order to undergo a tracheotomy, one has to submit to general anesthesia, so we very much expect that the pope was under general anesthesia when this procedure took place.

CNN's Jim Bittermann is at Gemelli Polyclinic Hospital. Jim, what more are you learning?

BITTERMANN: Well, I think -- something very small to add, but it's what they Namara Valls (ph), the papal spokesman, had say here at the hospital just a little bit ago to reporters. Basically called the operation, affirmative was a tracheotomy and he said that it was successful. Now, of course, that's a pretty relative term. I think as Dr. Gupta has been pointing out, you can have a successful tracheotomy, but there can all sorts of complications that would develop later.

One of the things that should be pointed out when they're saying and Reuters reporting that the pope is going to spend the night in his hospital room. He has -- I don't know if you can see it behind me here, an entire part, a section of this tenth floor of the hospital that is cordoned off just for him and, in fact, there would probably be just about every type of medical -- piece of medical equipment that there would be in an emergency care facility in that area.

So, to say that he's not spending the night in intensive care really is splitting some hairs, I think, in the sense that he's probably in, in a sense, in intensive care in his own hospital room -- Judy.

WOODRUFF: OK. Yes, Jim Bittermann explaining, as we've been discussing, that there's every expectation that His Holiness has access to all the medical care that he might need in that hospital room or hospital section that has been marked off for his use. Again, it is just after 4:00 in the East of the United States, it is just after 10:00 at night in Rome. We want to, again, welcome our international viewers, CNN's ongoing coverage of all the live and breaking developments around the health of His Holiness, Pope John Paul II.

I want to quickly bring in Robert Moynihan, who is the founder, the editor of "Inside the Vatican," the monthly magazine about the affairs of the Catholic Church. Robert Moynihan, you were just saying to me in terms of the pope's condition, that it's been observed that he was already having some trouble speaking. So, if you add the flu to that and any respiratory issues, one can understand why the complications would come along.

MOYNIHAN: Yes. They had noticed for the last couple of years that the stooping and then the tremors from the Parkinson's were making it difficult, even for him to speak. It's also a phenomenon of old age, to some extent. But his muscles were tightening. And it appears that the muscles in his chest are tightening and making it difficult for him to breathe.

WOODRUFF: And that makes it harder, presumably, recuperation. I want to touch on something else you just told me. You said it's just a week or so ago someone close to the Vatican said to you something to describe their mood, their attitude, if you will, toward the pope's condition.

MOYNIHAN: You mean with regard to...

WOODRUFF: With regard to succession.

MOYNIHAN: Yes. People are always thinking about that. They've been thinking about it for 15 or 20 years, even since the assassination attempt, who might succeed John Paul? And one friend of mine said he was really frightened -- the first hospitalization when he found out how near to death he had been because he said, we don't have anyone ready. And there are a number of candidates and cardinals that people talk about, but there's no one that really stands out that everyone feels would be a man of the stature of this man, who could lead the Catholic Church.

WOODRUFF: Why isn't there a process available to the church, to the Vatican, to have a more, if you will, predictable process of succession?

MOYNIHAN: Well, I would say first of all, this process seems to work fairly well because it's the longest-lasting institution on the entire planet. So for whatever defects it has, it has the record of longevity. It's a human institution, which seems to have a certain amount of faith that no matter what human beings do, something -- some spirit will come along and help guide it.

And that seems to -- Napoleon took the pope prisoner 200 years ago and said to the pope, "I'm going to destroy the Catholic Church." And the pope said, "If we priests haven't managed to do it, you certainly won't." So the church has this organizational structure and this procedure for electing popes and the successor for John Paul II. And that procedure has functioned in the past. There may be defects in it.

WOODRUFF: By the way, I'm just told, we have just been told, that there will be a live statement from Vatican officials in the lobby of the hospital shortly. And of course, CNN will bring that to you live as soon as it does get underway. I'm speaking with Robert Moynihan, who's covered the Vatican for many years. He founded the monthly magazine "Inside the Vatican."

As things now stand, how does the process of succession work? Clearly, we're not there yet. This pope is recuperating. He's sick, but he's recuperating, as far as we know.

MOYNIHAN: Yes. So in a way, it's something that we just talk about hypothetically. What the general principle would be. And that would be that if there's a need for a new election for a successor to the pope, for whatever reason, there would be a period of 20 days where all the cardinals in the world would gather.

WOODRUFF: Well, let me back you up. What would trigger that? It would certainly be the death of a pope, but what else might trigger that?

MOYNIHAN: There's been talk of a papal resignation. No one is sure what it means. It's almost unprecedented. People refer to a couple of cases in the past. Certainly there's no modern precedent for it. But people have been murmuring about it for a number of years and there's a rumor the pope has a letter saying if I'm unable to speak, if I'm actually incapacitated, here's my resignation.

WOODRUFF: This is just a rumor.

MOYNIHAN: This is just a rumor. It's sort of talked about in Rome.

WOODRUFF: The other thing you said -- you said in Rome or in Italy, what is it they say about getting the flu the second time?

MOYNIHAN: They say that if you get a relapse on the second occasion, your flu is often going to be worse. It's more tough to shake off.

WOODRUFF: This is just sort of conventional wisdom, old wives tale, as we call it in the United States.

MOYNIHAN: Often you do get a relapse of the flu. And the pope has had one and has taken it very hard. He could very well recover totally or, at his age, anything can happen.

WOODRUFF: Robert Moynihan, who watches the Vatican very closely, is the founder and editor of "Inside the Vatican." He's been covering that institution for many years. Kyra, back to you in Atlanta.

PHILLIPS: All right. Judy Woodruff there in Washington, D.C. I'm Kyra Phillips here in Atlanta. We're continuing our breaking news coverage. If you're just tuning in, we welcome our international viewers and our domestic viewers as we continue to follow the condition of Pope John Paul II after undergoing a tracheotomy here at Gemelli Hospital. You're looking at a live picture just outside the hospital there, where we are told that the operation was successful. The pope's condition is regular, according to the Vatican. The operation took about 30 minutes.

We have live coverage all around the globe from our Dr. Sanjay Gupta here in Atlanta, to Jim Bittermann, who's out in front of Gemelli Hospital there. And also, Delia Gallagher, our Vatican correspondent, who joins us now live from the Rome bureau. And Judy Woodruff was talking a bit about the future of the pope.

Delia, if indeed he were to resign, if indeed the decision had to be made that someone must replace the pope. But this is someone who has stayed pretty steadfast in his feeling that he was going to live out his reign all the way to the end. I was even looking back in 2004 that the pope made a rare reference to his age and physical condition during his annual Christmas message, this was just a few months ago, saying that the passing years make one feel an ever more intense need for help from God.

GALLAGHER: Yes, absolutely. And you could say, Kyra, that even as late as just last week he was giving that same message, saying that, you know, in today's society we tend to discard the elderly and think that they're not useful anymore and we push them aside. He says this is wrong. And he's giving the first example of that. He's not going to be pushed aside. So while resignation is a definite possibility for the pope, it's open to him to decide, he can resign. Church law allows for it. seems unlikely knowing his character and all the statements that he's made in the past, all indications are that is not something he would want to do.

Of course, it would present some problems, as well, because he would resign but he would still be alive and there would be -- we would need to elect another pope. The church would have to figure that out. It hasn't happened for centuries. So likelihood is that he is not going to resign -- Kyra.

PHILLIPS: What if he did resign? What if -- or his health just got so bad that the decision had to be made for him, if indeed that's even possible, what would the next step be? Is there a plan of action? Who would step in and take care of the process? I mean, kind of give us a feel for the what if.

GALLAGHER: Right. Well, the first point is that the decision to resign cannot be made for him. In the canon law, in the church law, the pope must resign of his own free will. That means he must decide and say when he is mentally competent that he has decided to resign. So that's part "A."

Part "B" is if the pope becomes incapacitated for some reason and has not written a letter to say that he wants to resign, who is going to decide that? There is no higher authority than the pope. And it is a big open question right now in church law. And canon lawyers are debating what exactly would happen.

One likely possibility is that the pope has written a letter, some people have said that this letter was written to say in the case that he becomes mentally incapacitated. However, somebody would need to decide at what stage do we which declare him mentally incapacitated. So it is a very big open and debated question at this point exactly how the church would proceed -- Kyra.

PHILLIPS: Considering everything the pope has been through in 26 years, Delia, from his nine operations to the assassination attempt to suffering from Parkinson's disease to the situation now, more than likely, do you think that letter has been written?

GALLAGHER: We have no way to confirm that, Kyra. And I don't think so considering what we said before about this pope. I think this pope thinks that the papacy is for a lifetime and God will decide when he needs to resign in the sense that God will decide when he needs to die.

So, that's probably the pope's definition of when he is going to resign. I don't know that the letter has been written and it seemed likely that that would not be something that he would even consider -- Kyra.

PHILLIPS: All right, Delia Gallagher, our CNN Vatican analyst there live from our Rome bureau. If you're just joining us, once again, real quickly, Pope John Paul II undergoing a tracheotomy after checking into the hospital for the second time within the past few weeks after suffering respiratory problems. According to the Vatican, the operation was successful, it took about 30 minutes.

The condition right now, as the Vatican describes it, is regular. We're continuing our breaking news coverage. I want to take you back to Judy Woodruff in Washington, D.C. -- Judy.

WOODRUFF: Kyra, thanks very much. And as Kyra said, the pope is now out of surgery and the Vatican has announced that he will spend the night in his hospital room or hospital suite at the Gemelli Polyclinic Hospital in Rome where he has been cared for. Now, this is his second visit there during the month of February.

Again, we want to welcome our international viewers, we preempted our regular program, "INSIDE POLITICS," to follow all the breaking developments around the health of His Holiness Pope John Paul II. With us now from Boston is someone who knows the Vatican well, knows its connection to the United States. He is the former United States ambassador to the Vatican, the former mayor of Boston, Ray Flynn.

Ambassador Flynn, what are you hearing about this pope's health?

RAYMOND FLYNN, FMR. U.S. AMBASSADOR TO VATICAN: Well, I talk to the Vatican on a regular basis. I've still have had a number of close friends now at this point, not just associates, but friends, including the holy father.

So I mean, earlier, well, 10 days ago, pretty serious, people really concerned. Today, even more so concerned. Today was an operation that was completely necessary in order to stabilize the health of the holy father.

So, while it is optimistic news, more optimistic news, I think people are really concerned about the frail health of the holy father and, again, I think the best prescription for the holy father at this point in time and for people across the world is to say prayers for John Paul II; A courageous, dedicated man, but at the same time, a very frail pope at this point in time.

WOODRUFF: Ambassador Flynn, to be very blunt, are people worried that he may not make it or are they worried that he may be in a -- that his condition may be such that he will not be able to carry on the responsibilities of being the pontiff?

FLYNN: Well, Judy, actually, the Vatican kind of runs itself. The trains will run on time. It's the health of the holy father in his strong, moral voice that he deals with political issues. The culture of life, stem cell research, the war in Iraq, all of these issues, the holy father is oftentimes the one only remaining lone voice that provides a moral component to complex political issues that people either have self-serving interest, countries, leaders or they do it from the standpoint of a political point of view where John Paul II and the Catholic Church interjects a moral component, a moral point of view.

That's why his voice is so critically important. And I guess that's the part that I'm most concerned about. Not so much who runs the trains and whether the trains run on time, but whether or not this moral voice is going to be muted.

WOODRUFF: We just -- I know you know Robert Moynihan, he's been our guest for the last hour or so, founder of "Inside the Vatican." He was telling me about how well you two know one another. He just said that he's been told -- was told several weeks ago by someone who knows the Vatican well, that, in his words, they were terrified about the pope's health because there is no clear successor. Do you get the same sense?

FLYNN: Well, there is no clear successor. You know, the holy father is the holy father and he is the leader of the Roman Catholic Church until he passes on and then it's a whole new ballgame. And anybody who can predict that -- Bob Moynihan at "Inside the Vatican" has as good an insight into that as anybody. But it's still a jump ball.

You can look at the map and you can study it and you can be aware of the -- inside the Vatican and at the same time you walk away saying, boy, I still can't figure out what is going to happen. So the holy father is in charge until he's not in charge, and everybody else, as the old saying goes, the frontrunner walks into the next conclave as the next pope saw it, as a cardinal.

So you never can predict what's going to happen at these conclaves. John Paul II, Karol Wojtyla, came into the conclave in 1978, and after 453 years of Italian rule, John Paul II walks out the first Polish cardinal to become the leader of the Roman Catholic Church.

WOODRUFF: Former U.S. ambassador to the Vatican, Ray Flynn, we hope you'll stay with us. Ambassador Flynn reminding us of the story and the history of this pope, who is in the hospital battling a serious case of the flu and more. Having just undergone a tracheotomy at Gemelli Hospital in Rome.

Kyra, back to you.

PHILLIPS: All right, Judy Woodruff, live from Washington, D.C., thank you so much.

I'm Kyra Phillips here in Atlanta, Georgia, as we continue our breaking news coverage. Pope John Paul II remaining in Gemelli Hospital after undergoing a tracheotomy. It was about a 30-minute procedure. As you know, the pope has been having respiratory problems due to the flu. He checked into the hospital back February 1st. He was there for nine days and then released for about 13 days and then he was checked back in today.

According to our Dr. Sanjay Gupta, having a tracheotomy, something that is usually decided on an emergency basis because of the difficulty breathing. John Allen, National Catholic Reporter, is another one of our analysts who has been followed this story for the past few hours with us along with our Jim Bitterman, outside of Gemelli Hospital.

We're keeping an eye also on -- you'll see here, a live picture inside Gemelli Hospital. We're told that we are expecting a statement here at this podium. We're expecting the Vatican to make a statement shortly here live on CNN. We will take it as soon as a representative steps up to the podium.

The only thing that we've heard from the Vatican so far via Delia Gallagher there at our Rome bureau, she's our CNN Vatican analyst, the Vatican said the operation was a success, that the tracheotomy went well, that 30-minute procedure, and that right now the pope's condition is regular.

So, we will take that live statement shortly, as soon as someone steps up to the podium. You saw the number of journalists there from the press. Sort of flocking that area. Another individual that's been covering this story for us as it's been breaking throughout the day, John Allen, National Catholic Reporter. He's with us quite a bit.

John, I know you're desperately trying to get back overseas to cover this story. You were in New York, so, we're continuing to talk to you. You're one of our best experts when the comes to Pope John Paul II. But we've been talking a lot about his 26 years. I just want to reflect a little bit, we've been talking so much about the surgery.

Actually John, actually, I believe we're going to take this statement live. Vatican official possibly getting ready to talk about this tracheotomy that took place and the condition of the pope. Let's listen in.

NICOLA CERBINO, HOSPITAL SPOKESMAN (through translator): ... read the statement of the director of the press of the Vatican.

The flu that led to the hospitalization of the pope in the Gemelli Hospital had some complications over the last few days. With episodes of lack of breathing, difficulty in breathing, which were already caused by stenosis.

This clinical situation led to an elective tracheotomy to ensure the ventilation of the patient and to favor the resolution of this pathology. The holy father has given his consensus after being informed. The surgery started at 20:20 and ended at 20:50. And the result was positive.

The pope is fine and he's going to spend the night in his room. The surgery was carried out by Mr. Gaetano Parudeici (ph), from the Sacra Quarte (ph) University, and Dr. Camaioni (ph), ear, nose and throat surgeon from the Sandravani (ph) Hospital in Rome.

The anesthesia was given by Professor Proiesti (ph) from the University of Sacra Quarte with the cooperation of Professor Massimo Antonelli (ph) and Dr. Filippo Zongi (ph). The surgery was attended by an Mr. Enrico de Campora (ph), an ear, nose and throat doctor from Florence Hospital, and Dr. Renato Butsonati (ph) who is the personal doctor of the holy father.

PHILLIPS: Once again, that was a live statement there coming from the hospital. Hospital spokesperson Nicola Cerbino updating us on the surgery that Pope John Paul II underwent. He said that the pope checked in today due to complications from the flu. He had a difficult time breathing. But after the tracheotomy, the positive -- he says the results are positive, that the pope is fine. He will spend the night there in the hospital, and then he named all the doctors throughout Italy that helped perform that surgery. A group of doctors from throughout Italy.

And we were talking with Dr. Sanjay Gupta here about the tracheotomy, about the medical attention that the pope has been receiving there in Italy.

You even mentioned how good the hospital care and the doctors are in Italy, specifically the ones that have been dealing with the pope.

GUPTA: Yes. And, you know, in frame of reference to the Vatican itself which also has excellent medical facilities, as soon as we heard that the pope was being taken to this hospital there close to the Vatican, it raised our antennas as to whether or not he might be having something more done that can be done at the Vatican itself.

You heard the procedure just described as an elective tracheotomy. That might be a little bit of a misnomer. Elective typically means a scheduled operation. In this case what we do know is that the pope did go to the hospital with some breathing difficulties.

So at a minimum I think you would call this probably an urgent tracheotomy. This wasn't something that they wanted to schedule a week from now, for example, but rather get done rather quickly. Taking about 30 minutes. Biggest concern about procedures like this, not so much the operation itself, but rather the anesthesia associated with that.

As we're hearing, the operation a success. We still have to wait, as all surgeons and doctors and anesthesiologists do, wait to see how the pope wakes up from that. No reason to believe that he shouldn't wake up completely fine -- Kyra.

PHILLIPS: So, more than likely, how long will he be sleeping -- I mean, how long does it take to come out of the anesthesia after something like, considering he's 84 years old?

GUPTA: Typically in a healthy person it would be almost right away, even within the operating room itself, you get a sense of the patient being awake, nodding their heads, being able to follow some simple commands.

Being that he's 84 years old, they may go ahead and leave him on some of the medications a little bit longer so that he wakes up more slowly with less pain. He'll probably going to be in -- and they're saying he's in his room that probably has a ventilator in that room so that they can provide breaths for him while he's slowly waking up.

He may need to be on this ventilator for an extended period of time now that the tracheostomy is in. Again, those details not yet available, but that's sort of from a medical angle probably the most likely course.

PHILLIPS: Is it possible that the trach could remain there within the windpipe for the rest of his life?

GUPTA: That is usually not the intention of a tracheotomy like this, unless someone had some other reason to have it. For example, a cancer or something of the upper airway, which he doesn't have. Most commonly the goal is sort of to go ahead and put the tracheostomy in, to go -- to be able to clean out his lungs and provide his airway for a certain period of time and then to remove that and allow his neck to actually close up over that scar.

PHILLIPS: My colleague Judy Woodruff in Washington, D.C., also both of us here handling the breaking news coverage. Judy actually has some questions for you, Dr. Gupta.

WOODRUFF: Sanjay, if I'm hearing you correctly, I'm hearing you using both the term tracheotomy and tracheostomy, which is it, or is it both?

GUPTA: It really -- good question, actually. Those terms are actually used interchangeably, for the most part. Both terms really referring to an operation actually being done on the neck between the adam's apple and the breast bone to put that tube into the airway.

WOODRUFF: Sanjay, again, on that point you were just talking to Kyra about, the fact that the spokesman made a point of calling it an elective tracheotomy, and then I believe he went on to say the holy father chose to do this, making it sound as if it was something that -- where there was a choice?

GUPTA: Well, you know, this is interesting. Typically all operations consent is required from the patient and no matter who the patient might be, in this case, the pope. So probably the options were sort of deliberated with the pope. One thing, Judy, that is interesting -- I think, most interesting from a medical angle is that typically what happens is a tube is typically placed from the mouth down into the airway as a first step and then possibly a tracheotomy later on down the line.

Why was it done as a first step, the tracheotomy itself, probably because he had some significant swelling or inflammation of his airway. And the tube going from above just wasn't possible.

The reason I chose my terms carefully about elective, they just said that in the press conference that it was an elective tracheotomy. I think most doctors would say, listen, he came to the hospital today with breathing difficulties. The whole goal of being in the hospital at this point is to secure the airway. This tracheotomy isn't something you'd schedule for next week because he's having more difficulty breathing. That needs to be done on a more urgent nature. And that's why I chose that term to be a little bit different there -- Judy.

WOODRUFF: And I guess I'm just simply picking up on what Kyra was asking you in terms of what do you look for next here? How long does it take him to get better, but how do you determine that?

GUPTA: Yes. You know, the anesthesia really a bigger concern than the operation itself, again, being that he's 84 years old and has existing medical problems. They're probably going to let him wake up a little bit more slowly from the anesthesia.

I imagine that process could take a couple of hours and then he'll be in his room, his own hospital room probably on a ventilator providing breaths for him, at least in the short term. Unclear how long he will need a ventilator or something like that in the longer term.

He should be able to be with it, as we say in the medical world, being able to communicate not by speaking, but being able to make gestures or even writing as best as he can probably within several hours, maybe by tomorrow.

WOODRUFF: So, Kyra, you and I have lots of questions and fortunately we've got some smart people to help answer them, like Sanjay.

PHILLIPS: That's true, we've covered a lot with regard to the pope, Judy, that's for sure. But we are turning to all our experts, from Dr. Sanjay Gupta to, of course, our Jim Bittermann, who's outside of Gemelli Hospital right now.

Jim, you heard -- were you actually in the room when the hospital spokesperson, Nicola Cerbino, made the statement? If so, do you want to recap what he had to say?

BITTERMANN: Well, basically, I wasn't.

I was up on this cliff up outside the hospital, but I did hear the statement. And Nicola Cerbino, I should point out, was reading a Vatican statement. This is going back to what we saw here the last time the pope was here, and that is that nothing comes out the hospital without the Vatican approving it.

This was actually written by the Vatican. And I think Judy picked up on the two operative phrases that really stuck out to me, a little bit of the Vatican sort of controlling the information in a way or maybe and spinning it a bit, saying that this was an elective tracheotomy.

And, as Dr. Gupta pointed out, that's a little bit of a stretch because, obviously, you don't undergo an operation like this unless it is really necessary and that the pope consented to the operation, giving the appearance that the pope was conscious and was making decisions and taking decisions.

Again, this is the kind of thing we've seen in the past from the Vatican, this effort to sort of make it look like, in fact, the pope is on the road to recovery, is taking decisions on his own, is opting for things, when they may be much more necessary than we're being led to believe.

But Nicola Cerbino said the operation lasted from 8:20 local time to 8:50 local time. That was about two hours ago. And that the pope came out of it. It was a successful result, and that he is now spending the night in his hospital room.

But, again, that's kind of splitting hairs, because his hospital room is actually a hospital suite, which is very well-equipped. Indeed, it could be just as well described as an intensive care area, because there are just about the same kinds of equipment you would find in intensive care in his area up on the 10th floor there -- Judy, Kyra.

PHILLIPS: That type of suite, Jim, I'm just curious. Is this an area that is solely for the pope and only the pope, that there wouldn't be any other type of patient that would ever use the facilities in this room?

No. In fact, this area, it's is a whole area up on the 10th floor here. This is huge hospital complex, I should tell you. It's a teaching hospital. It's very accessible.

In fact, there are constantly people coming in and out of the lobby of the hospital area. I was able to -- last time, because I was down here for the pope's illness. I was able to get up to the 10th floor, but that didn't mean I was anywhere near where the pope was, because in fact there is an area that is cordoned off with locked doors and whatnot around the area where the pope is.

So, it's not accessible. It is basically reserved full time. This is also a Catholic hospital, so it is basically reserved full time for the pope and any kind of problems the pope would have. I think they do probably take people in there, other people in there when the pope was in good health, but when the pope is in bad health, it is reserved strictly for him.

And then the rest of the hospital goes on with its business. One thing I should say, in that long list that Nicola Cerbino had there of all the different doctors that were involved in the operation, one thing that the Vatican has done traditionally is, it made medical decisions by committee. And they have always sort of taken the pope's health as kind of a collective thing, especially since the diagnosis of Parkinson's about 10 years ago, 10, 11 years ago.

Since then, the medical committee has made all sorts of decisions. And each one of those doctors that was chosen, I am sure, was chosen because he was the most outstanding expert in the field available this evening who could be brought here and take part in the operation -- Kyra. PHILLIPS: Jim, just one quick question. You mentioned the spin with regard to the condition of the pope. And maybe it appears to be a it little more positive that what might actually be going on. If you look at this situation and how it is being handled with regard to information and the flow of information with regard to the pope's condition and then you look at the other nine operations he's gone through, even his assassination attempt. Would you say that, right now, just considering his age and his condition and what he has been going through recently that there might be an even bigger sense of privacy or possible spin on what is truly going on at the moment?

BITTERMANN: Well, I think there's a greater wall of protection against the pope right now.

I think that, in the past some of his ailments, for instance, were pretty obvious, when he was shot, obviously, but also later on, when he fell down and broke his leg. There had been once in Poland -- I was along on a trip in Poland where he had kind of a dizzy spell and fell down and there was a small cut on his head and the Vatican spokesman had to come out and explain that.

So, the Vatican can be forthcoming when they have to be. But, in a situation like this, I think they guard the information very privately. And so we're not being told a lot. We're not getting a lot of detail. And, as has happened frequently in the past, not just with John Paul II, but with other popes, there really is no clue about the real conditions of the pope's health.

We found out only long after the fact about how bad, bad off Pius XII was during his last four years of papacy. And not much has changed since then. Basically, today, the Vatican keeps these things a secret and they don't let out any more than they really have to.

PHILLIPS: Jim -- Jim Bittermann outside Gemelli Hospital there as we continue our breaking news coverage on the condition of Pope John Paul II there in the hospital after undergoing a tracheotomy, the Vatican saying that procedure a success.

We're going to go back to Judy Woodruff in Washington -- Judy.

WOODRUFF: Thanks, Kyra.

Just recapping, as Kyra did, Pope John Paul II is in the hospital. He did undergo a tracheotomy. The Vatican is saying it went successfully. The outcome was positive. The pope does now have a tube in his neck, giving him a passageway wherein he can breathe and breathe clearly. The procedure took place, a spokesman said, at 8:20, which would be 8:20 in the evening, Vatican time, which would have been about 2:20 Eastern time here in the United States.

It lasted half-an-hour. The pope is recuperating now and he will stay in the hospital overnight. We again want to welcome our international viewers. It's just about 36 after 4:00 in the afternoon in the United States, about 10:36 at night in Rome. We're waiting for a statement, we're told, that is going to come from a spokesman from the Italian prime minister, Silvio Berlusconi. When that statement begins, we'll go to that live.

In the meantime, I think Ray Flynn is still with us in Boston.

Ambassador Flynn, you still there?

FLYNN: Yes, I am, Judy. Hi.

WOODRUFF: Thank you for talking with us a little bit more. Ambassador Flynn, of course, was the U.S. ambassador to the Vatican during the administration of Bill Clinton.

Ambassador Flynn, how well-equipped is the church to withstand transition right now?

FLYNN: Judy, I've been noticing that there's a lot of tentativeness here in terms of describing the holy father's health.

We in American politics, you know, are more forthcoming with information about the health of a particular leader, for many reasons. The press would put a lot of pressure. People want to know. But for good reason, there is not a lot of information that is disseminated about the health of the holy father. Some people have referred to it as spin.

I'd put it in a more affectionate way. He is the leader. The pope is the leader of the Roman Catholic Church. There is no process where somebody immediately succeeds him, like the vice president of the United States. This would be a brand new ball game, a new set of rules, new day, if you will, a new philosophy in many respects for the church.

So, they will be not guarded, not pin, but very cautious, very concerned about putting out information about the holy father. So, I hope people understand that this is not some sort of way of trying to keep the people in the dark. This is to assure the stability of the Roman Catholic Church throughout the world, so that there is a continuity of leadership.

And only when the holy father passes on or, in the unlikely situation, resigns, do you start getting the words of new leadership, a new leader. That just doesn't happen. So, I hope the people understand that this is -- this is done for the most effective way of maintaining the stability of the church.

And if I can also say this, Judy, when you think about it, you know politics as well as anybody. You know, this is a moral voice that deals with profound, incredible, crucial political issues. There's no voice like this in the world. There are political voices. There are voices of certain ideology, but there is no voice that deals specifically with the moral component of very, very complex political, difficult issues.

WOODRUFF: Well, we certainly appreciate that perspective from someone, an American, who knows the Vatican very well from having been the U.S. ambassador to the Vatican.

Ambassador Flynn, to get back to the question, though, about the church itself, how well-equipped is the church? Is the church in a position now to withstand transition and remain as strong and apparently together as it is right now?

FLYNN: It's a good point.

Two questions, Judy. I'd just like to point out that, before I was United States ambassador to the Vatican, I was a longtime friend of Karol Wojtyla. I first met him in September of 1969. So, I have had that personal relationship with him over the years.

So, it's not just an ambassador-pope relationship. It's a personal relationship. So, I think that's important because I am deeply concerned about this man. I love this man. It's not just some sort of professional-political -- political relationship. He's a friend of my family.

Judy, the other question about how well the church is going to move forward with a new pope, it's going to be the most extraordinary dynamic in my lifetime. It really will be. There's all kind of pressure. There's all kinds of and people weighing in to bring reform, to bring change to the church. On the other hand, there's an incredible political movement to make the church even more traditional, more conservative, if you will.

And there is going to be one of the most fascinating political dynamics in my lifetime. It is going to be almost like, you know, Franklin Roosevelt, president to the United States and he's replaced by Barry Goldwater. I mean, it will be that kind of a change, although the College of Cardinals will say, no, we maintain this level of continuity.

But when you're a leader of the Roman Catholic Church for 26 years and there are a lot of these issues on the table, there is going to be a lot of debate and there are going to be a lot of people who want to weigh in.

WOODRUFF: Ray Flynn, former U.S. ambassador to the Vatican, we thank you very much for your insights.

He's joining us from Boston.

Ray Flynn, by the way, will appear on CNN later tonight on "NEWSNIGHT WITH AARON BROWN." That's at 10:00 Eastern.

We're going to take a short break. We'll be back with another live report from Rome. We're also going to speak again to our medical correspondent Dr. Sanjay Gupta about the condition of the pope.

But, first, a short break.


PHILLIPS: I'm Kyra Phillips here at the CNN Center in Atlanta. We're following two breaking news stories for you at this hour. First, Pope John Paul II remains in Gemelli Hospital, not far from the Vatican, recovering from a tracheotomy. We're going to continue to follow our breaking news coverage on that.

But back here in the United States, another story that is breaking this hour, this out of Tyler, Texas, pictures here WFFA, our affiliate in Dallas, Texas. We're told a man with a high-powered rifle opened fire in the tow square near the courthouse, killing two people and wounding two law enforcement officials before being shot and arrested.

A Smith County sheriff's deputy, a Tyler police officer and a civilian were injured, the fatalities, a man and woman, not law enforcement officers. We're told that the suspect was also shot at the scene. He then fled the scene. Officers gave chase. He is now in custody, being treated at a hospital. No identities at this point have been released.

We can tell you that the gunman was believed to be upset about a court case. That's why he opened fire here in front of this county courthouse, Tyler, Texas, about 95 miles east of Dallas, Texas. We will continue to follow this story breaking out of Tyler, Texas, not far from Dallas, a man with a high-powered rifle opening fire, killing two people, wounding three others, now in custody. He was also shot himself. We'll continue to update that story for you.

Now back to our bigger story overseas, and that is the condition of Pope John Paul II. We can tell you that he did undergo, according to the Vatican, a successful tracheotomy. He had difficulty breathing. As you know, he's been suffering from the flu, been having respiratory problems. Today, he checked himself into the hospital, once again undergoing what our Dr. Sanjay Gupta says is an emergency procedure, a tracheotomy, where a tube was inserted to help the pope breathe more sufficiently without difficulty, as we previously told you.

We want to go back to Delia Gallagher, our CNN Vatican analyst. She's coming to us from our Rome bureau. Just to kind of give us an update of what we know and the pope's condition. He'll be spend the next 24 hours at Gemelli Hospital.

Is that correct, Delia?

GALLAGHER: That's right, Kyra, and probably even longer. It is good news for the pope in one sense. He made it through this tracheotomy operation, but we have got to see in the coming days how he does, when he comes out of the anesthesia, when he continues to try to speak.

These are going to be some of the elements that we have to watch, because the voice is one of the last instruments the pope has left to communicate. And he wants to use it. So, this is going to be something that everyone will be monitoring very closely. And, surely, the pope will be concerned to get back here to the Vatican. We've seen him in the hospital before and we've seen him come out before. So, all expectations and indications suggest that he's OK at the moment. Good news for him -- Kyra.

PHILLIPS: And, of course, no suggestion of a resignation at this point or anybody taking the pope's place. He has remained steadfast in his mission. And that is to continue on as the pope all the way until the end.

I know there's been a lot of debate, a lot of talk about what would happen if, indeed, the pope did resign or if something did happen to the pope, Delia. But, at this point, we can't even, we can't even entertain that idea, can we?

GALLAGHER: Well, it's an open question. Of course, the pope can resign. And discussion of that was raised when he was brought to the hospital two weeks ago.

But all indications from the pope are that he has no intention of doing so. We talked about how he has got this very strong desire to continue in what for him is a vocation, not just a job. And it is a lifetime vocation. So, I think that he will continue in that until God decides that it is his time to go. I don't think that he's going to be the one to do that, although it is allowed for in church law.

If the pope, of his own free will and in his mental faculties, is able to say, I resign, he can certainly do that. And we heard Cardinal Angelo Sodano, who is the secretary of state, say just a few days ago that that is still an open question and he leaves that up to the conscience of the pope. And that's the sentiment of the most of the cardinals here at the Vatican -- Kyra.

PHILLIPS: And the conscience of the pope remaining very strong with regard to that gospel of suffering. That is for sure.

Delia Gallagher, our CNN analyst there in Rome, thank you so much.

We're going to take it back to Judy Woodruff in Washington, D.C.

WOODRUFF: Kyra, thank you.

And, as Kyra's been reporting, CNN is following very closely the health of Pope John Paul II, his holiness brought to the hospital this morning, Rome time, about 5:00 a.m. Eastern time here in the United States, breathing difficulties, the Vatican saying it was complications of the flu.

And we know that, just a few hours ago, the pope underwent a tracheotomy. The Vatican is saying it was successful and they're saying he will spend the night at the hospital.

With us now is someone who knows the Catholic Church as well as anyone in the United States, certainly as well as anyone in the world, for that matter. He is Father Brian Hehir. He's a professor at Harvard University, a longtime adviser to U.S. -- of U.S. Catholic bishops. Father Hehir, I know you have been following all these developments with great interest. What is on your mind as you think about the health of the pope?

REV. J. BRIAN HEHIR, HARVARD UNIVERSITY: Well, I think it's multidimensional. As a priest of the church, I pray for him, of course, and pray for the life of the church because of the centrality of this office and the centrality of this personality in the history of the church in our time.

I think, secondly, there are obviously -- the interest of the world in what is happening is testimony to the impact that he's had on the world. I think it's an impact that has gone far beyond the Catholic Church and, therefore, I think it's important for all of us who are inside the church to try to make intelligible as we can what's going on and try to communicate with the wider interested public.

And then, thirdly, the two broad areas in which the pope has been so decisive, the internal life of Catholicism and its impact on the world in the larger political and public sense, those questions are, obviously, the questions that any of us will want to analyze in terms of where he is, where the church is and where things may move in the short-term future.

WOODRUFF: Father Hehir, is the Catholic Church in crisis when a pope is having difficulties, as this pope is now?

HEHIR: No, I don't think so.

I mean, it is an institution that has procedures in place to handle transition. I think you asked earlier, one of your other guests about, is it ready to handle the transition. And I think, if there's any institution that had experience with this kind of transition, this one. So, in one sense, the formal structures of carrying through the transition are all in place.

Now, what the outcome would be if the holy father died, obviously, then you enter into the whole process that is undefinable, not in terms of its structure or procedures, but in terms of its outcome. But I don't think it's crisis. I think it's a matter -- it's a time of reflection and, to some degree, prayer, as a constant aspect and also analysis of what needs to be done to support him in his illness, to provide for the leadership in the church in light of his being the pope, but being disabled at this time.

Those things, I think, are in place. And, obviously, it's very complicated. I don't want to communicate any other sense than that, but I think crisis would be the wrong term.

WOODRUFF: And I just want to ask you, though, one other thing, Robert Morgan -- I'm sorry, Moynihan -- who was with us just a few moments ago, the founder of "Inside the Vatican," the magazine, said to me at one point, he said, there are so many factions in the Catholic Church, he said, in a way, they're being held together by inertia. He said they could fly apart if something were to happen to this pope. Do you share that view? (CROSSTALK)

HEHIR: I wouldn't be convinced by that analysis.

I think, obviously, he is the -- the pope is the visible center of unity for the church. And we are a very pluralistic church at this time. I don't doubt that. But, for myself, anyway, I do not see the signs of things flying off into different directions without any ability to hold it together within the broad circle of the church. I wouldn't be that impressed by that analysis.

WOODRUFF: Father Brian Hehir, he is professor at Harvard University, someone who has long served with distinction in the Catholic Church.

Father Hehir, thank you very much.

HEHIR: Thank you.

WOODRUFF: We're going to take a short break.

When we come back, some medical analysis from our correspondent Sanjay Gupta.


PHILLIPS: And the breaking news continues with regard to Pope John Paul II's condition, now in Gemelli Hospital for the second time in the past few weeks, we're told, after undergoing a successful tracheotomy. That's according to the Vatican. Now we are told the pope will be resting there at the hospital for at least the next 24 hours.

As you know, he checked in back in February with respiratory problems due to the flu. He started to have those same breathing problems today, immediately rushed to the hospital, underwent this surgery. And now we're being told that operation was a success.

Dr. Sanjay Gupta continuing to help us follow up on the surgery, what it means to the pope after this surgery.

Why don't you just kind of backtrack for us, tell us what happened and what goes -- what life will be like now?



I mean, twice in a month now, he was hospitalized. From what we learned from his first hospitalization, he had significant what they call laryngospasm, a big word. Basically, it just means that the upper part of his airway was in spasm, a pretty significant problem, certainly something that would warrant a visit to the hospital.

But he did not require any kind of tracheotomy or any kind of breathing tube during that first hospitalization. He was in the hospital for about 10 days. Readmitted -- we find that he was some having difficulties breathing again, is what we were hearing, although he was relaxed at the same time, is what the Vatican is reporting.

Those two things don't exactly reconcile, but what we have learned most recently is that the breathing difficulties were significant enough where he required a tracheotomy. This is an operation. This is an operation where you actually make an incision. I have got a model here. Let me try and show you what that operation entails.

You actually make an incision in the side of the neck here. Let's see if you can see that. Actually, in the front of the neck here, and then a tube is actually placed directly into the trachea, into the air pipe, creating a sort of conduit, so that someone may be able to breathe more easily.


PHILLIPS: Sanjay, pause for just one second.

We want to take our viewers straight back to the hospital. I understand we're getting a statement now from the prime minister's spokesperson. Let's listen in.


GIANNI LETTA, ITALIAN PRIME MINISTER'S SPOKESMAN (through translator): It depends on who you're talking when you say it's minor.

So, he even joked on his surgery when he woke up with the same spirit. He went like this with his hand, as if he wanted to say, I'm still going to reproach you. So, it means he's fine. The doctors are satisfied with the way he has undergone the surgery and also as far as the first hours after the surgery.

The atmosphere was very calm. And the doctor and all the other doctors who followed the doctor here were very reassured. They're going to sleep here tonight, as well as the surgeons in particular, Mr. Peroyeti (ph), who described the surgery to me. And the reasons why the pope undergone this surgery, the reasons are clear, as explained by the statement, that is to say to allow the pope to breathe in a better way and to restore the inflamed larynx, which was the cause of the breathing difficulties.

So, everything is going well. I was very worried when I came in the hospital, but now I am relieved. Thank you.

The pope went like this with his hand. And he said, these doctors. But the doctors asked him not to talk, because the surgery was carried out because of the breathing difficulties and because of the inflammation of the larynx. And, as explained by the statement -- I'm not a doctor, but the statement says that the larynx conditions are to be restored.

He's fine. He's fine. And he's tranquil. You have to help me, because I don't speak English, so I cannot repeat in English. Thank you, goodbye.

PHILLIPS: He's fine and he's tranquil according to Silvio Berlusconi, the prime minister of Italy, his spokesperson there actually saying that the pope waved his hand but was told not to speak due to the recovery after his tracheotomy. He said he was worried at the beginning, now he is relieved. The atmosphere is calm. The pope will be spending the night in the hospital as will all his doctors. They will be spending the night there as well.

According to the Italian prime minister's spokesperson, the pope doing well after successful surgery. Stay tuned, our breaking new coverage of Pope John Paul II and his condition after a tracheotomy today will continue.


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