'PRECIOUS' SUFFERING

The face in the window high above St. Peter's Square is small and distant and, even when viewed through a long lens, almost without expression. The voice quavers, just a few words breathed with excruciating effort, audible over loudspeakers, but only barely comprehensible. Few people can get close enough to Pope John Paul II to try to read the thoughts behind the mask of sickness on a Sunday morning, but some of those who have approached him say they've glimpsed the pain of a man with a vital mind, a man who has loved life enormously, trapped now in a body that brings him nothing but suffering. "You can see it in his eyes," says such a priest. "To be imprisoned like this must cause him tremendous agony."

And yet--because he is the leader of a billion Roman Catholics; because he is the first pontiff of the satellite and Internet age, reaching out to billions more, and because he is John Paul II, who has ruled the church for more than 26 years--in that public experience of suffering lies enormous power. And he knows it. More than 20 years ago, after recovering from the pistol shot that almost took his life in front of St. Peter's, John Paul declared that suffering, as such, is one of the most powerful messages in Christianity. "Human suffering evokes compassion," he wrote in 1984, "it also evokes respect, and in its own way it intimidates." In 1994, as age and infirmity began to incapacitate John Paul publicly, he told his followers he had heard God and was about to change the way he led the church. "I must lead her with suffering," he said. "The pope must suffer so that every family and the world should see that there is, I would say, a higher gospel: the gospel of suffering, with which one must prepare the future."

Now, to the frustration of some reformers in the church who would like to see the 84-year-old pontiff resign, John Paul's personal Calvary has become his most powerful message. Every tremor in his hands takes on meaning. (Although the Vatican has never officially confirmed the details of John Paul's principal afflictions, senior clerics admit privately that he has Parkinson's disease.) The spectacle of his condition crystallizes his ferocious attachment to life--the most central, coherent and consistent teaching of his papacy--whether that life is threatened in the womb by abortion, or in old age by euthanasia.

A sense of high drama about the pope's condition intensified when he was rushed to a hospital on Feb. 1, with complications from the flu. He is so frail that he nearly died, and he might well have slipped into a coma. Now, this week, a conference is being convened in Rome that's expected to recommend maintaining life support even for people in a "permanent vegetative state" without any discernible brain functions. Inevitably this raises questions about just how long the pontiff himself might be kept alive if he is ever reduced to such a condition. Yet the chances of John Paul's stepping down, or being removed, are slight.

Many Catholics see the pope's suffering as something like the agony of Jesus himself, and neither John Paul nor those around him discourage such comparisons. When asked a few years ago if he might consider resigning, John Paul reportedly asked, in reply, "Did Christ come down from the cross?" His close aides say that debate about his ability to administer the church, as if he were the CEO of a secular corporation, essentially misses the point. This pope is not doing a job, he is carrying out a divine mission, and his pain is at its core.

This exaltation of suffering may be difficult for many non-Catholics to understand. (Protestant crosses, typically, do not depict Jesus at all, much less in the death throes shown by Catholic crucifixes.) Mel Gibson's film "The Passion of the Christ" attempted to convey the power of suffering in a way that was graphic, accessible and not a little sensational. But suffering, scholars point out, is at the very core of the faith; it is the vital link between the human experience and that of Christ as savior. He was a suffering victim who seemed to have been defeated by the earthly powers of his time. But in his moment of apparent weakness and defeat, Christians see him as triumphant, dying for humanity's sins and opening the way to heaven.

"The cross is not just something you hang on the wall," says Father Justo Lacunza-Balda, a missionary and director of the Pontifical Institute of Arabic and Islamic Studies. "Christianity is not born in a laboratory or a schoolroom; it's not conceived in an institute of higher learning. It's about suffering, torture, the experience of Christ on the cross." And it is about hope. In Africa, for instance, where the Catholic Church is growing faster than anywhere else in the world, the afflicted pope can be seen as "a living presence of the very essence of Christianity, which is the cross--and resurrection," says Lacunza-Balda. "He's not just an icon, he is the incarnation in his whole life of the message of Christ."

In the pope's 1984 treatise on the redemptive power of suffering, "Salvifici Doloris," he argued that suffering is not punishment for a crime or a sin. As Job understood, as Isaiah preached in the Old Testament, and as Christ taught in the Gospels and in his life, suffering is merely part of the human condition--and can best be answered with love. "Suffering seems to belong to man's transcendence," wrote John Paul. "It is one of those points in which man is in a certain sense 'destined' to go beyond himself."

But the pope's physical decline increasingly raises the question of how much longer he will be able to function. Who will run the Catholic Church, and how, if John Paul is still alive but no longer able to make his wishes known? His suffering may be a powerful symbol for good, but it could be exploited cynically if the pope grows much weaker. Few in the church would challenge the pope's commitment to life, but they question an autocratic system that he has strengthened during his reign. As Catholic historian Eamon Duffy, at Cambridge University, writes, dissenters have seen "local Churches disempowered, intellectual enquiry stifled, women disparaged, clericalism and curial bullying encouraged, and, in the Vatican's repudiation of liberation theology and its campaign against condoms in AIDS-ravaged Africa, the poor betrayed."

"No one with a heart could withhold admiration for the indomitable courage and sense of vocation which drives [John Paul] to such endurance," writes Duffy. "No one with a head can fail to ask whether the Church is best served by the long infirmity of its chief pastor, or to wonder what weeds flourish round him as his energies and focus fail."

Indeed, as the pope's weakness becomes more pronounced, critics wonder if the Vatican's bureaucrats will be doing his bidding, or making up their own policies in their own interests. After all, if John Paul dies or resigns, their own power in the church hierarchy is likely to evaporate. Hence the suspicion with which some theologians view the new doctrines about sustaining terminal patients through extraordinary means. "The right-to-life types want to renounce brain death and keep everyone going forever," says John Paris, a Jesuit theologian at Boston College who has been writing about end-of-life issues for 30 years. "It seems that Lenin's mausoleum will be the model for the future. The entire enterprise is mischief-making at the Vatican."

There is no known cause for Parkinson's disease, and there is no way to cure it, but its progression is not a mystery. In a small part of the brain called the substantia nigra are cells that help control the body's automatic movements. The symptoms of Parkinson's begin when most of those cells have died or been destroyed. Limbs often tremble uncontrollably: in John Paul's case, his left arm. The most basic movements--walking, talking, swallowing, emptying your bladder--become a test of will between mind and body. "Imagine yourself encased in armor," says Dr. Abraham Lieberman, medical director of the National Parkinson Foundation in Miami. "You can't walk as well. You fatigue more easily because everything is more of an effort." The upper body can contract and you develop a stooped posture. This affects breathing. "A normal person takes 14 to 18 breaths a minute," he says. "The pope is probably double that, because he can't take deep breaths. And if you take short breaths, that exhausts the muscles more."

In advanced stages of the disease, patients need help doing basic things, like getting dressed, going to the bathroom. "To go out, you need people around you, making sure you won't fall and break something. You have trouble turning over in bed at night," says Lieberman. Eating is a major problem, because swallowing, which seems so simple for a healthy person, is really a complicated process, involving coordination of several sets of muscles. If your windpipe doesn't close off automatically, and quickly, you can choke to death.

Lieberman has studied pictures of the pope and believes the first signs of the disease were evident as early as 1986, when his posture began to be stooped. That could mean he had warning signs as many as 19 years ago. The first reports of tremors in the fingers of his left hand emerged in the early 1990s. In addition to the stooped posture, the pope does not speak loudly or clearly. But in his public appearances, he shows no signs of dementia, which sometimes occurs with the disease. "Given how long he's had Parkinson's, I'm amazed at what he's doing--appearing in public, giving talks," says Lieberman. "Lots of patients become apathetic and don't want to do anything. Most people would have given up by now. That speaks to the pope being a very remarkable person."

It's not clear which medications John Paul may be taking, or how effective they are. Dr. Enrico Fazzini, a Parkinson's disease expert and associate professor at New York University, says physicians with connections to the Vatican consulted him "about nine years ago" to find out which medications might help the pope's tremor. Last year the London Times reported that the pope takes levodopa, a standard treatment, and before public appearances or officiating at a mass he reportedly also receives a shot of the fast-acting drug apomorphine hydrochloride, which is effective for only a short time.

As the body becomes more fragile, the risks of fatal accidents and complications increase. "Chances are, the pope will ultimately die from a fall or some type of infection," says Fazzini. Although the pope is moved about in elaborately constructed "thrones," if he should fall, he no longer has the reflexes or strength to stop himself crashing onto the floor. Hospitalizations bring new dangers. "The hospital is a bad place for Parkinson's patients," says Fazzini. "They're not breathing well, and there are a lot of drug-resistant bacteria." Coughing is crucial to removing the infection if a respiratory infection sets in. But Parkinson's patients don't cough well, with their weakened muscles. "It's hard to muster a powerful enough cough to bring up mucus from the lungs, especially if their posture is stooped, as the pope's is," says Fazzini. "If they get infected, it's a nightmare."

On Feb. 1, just such a nightmare appeared to be unfolding. According to the Catholic magazine Inside the Vatican, edited by Robert Moynihan, the pope was essentially choking to death, but despite entreaties by his personal secretary, Bishop Stanislaw Dziwisz, and his physician, Renato Buzzonetti, John Paul refused for four hours to go for emergency treatment. Finally he had to be rushed to the intensive-care unit at the Gemelli Hospital. "If he had come in 10 minutes later, he would have been gone," Moynihan wrote, citing doctors as his sources.

John Paul was released from the hospital after nine days, and appeared at the window of his Vatican apartment the following Sunday. In a written message, the pope told the world's sick, "Your suffering is never useless... it's a precious thing." He remains in a very delicate condition. Last week was the annual Lenten retreat for Vatican officials, and for the first time in his papacy, John Paul did not attend. He has always celebrated mass at the end of the event, but last Saturday he did not. Cardinal Angelo Sodano, his most-senior aide, presided in his stead. Yet the pope's absence had a power of its own. It contained questions: about life, about suffering, about the nature of God.