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Pope John Paul II's Condition Worsens

Aired April 01, 2005 - 13:15   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.


BETTY NGUYEN, CO-HOST: Thank you, Wolf. I'm Betty Nguyen in for Kyra Phillips today.
MILES O'BRIEN, CO-HOST: And I'm Miles O'Brien.

It is about 8:15 in the evening at the Vatican. The sun has set on what appears to be a fateful day in the life of the Roman Catholic Church and all around the world. It's already been a trying day, with Pope John Paul II's already grave medical condition said to be further deteriorating.

A worshiper in Saint -- John Paul's native Poland seemed to speak for Catholics everywhere when she told a reporter, "I want him to hold on, to hold on, but it's in God's hands now."

Our coverage this hour begins with CNN's Alessio Vinci and Jim Bittermann, both of them in Rome. Alessio is at the Cathedral of St. John Lateran, where the vicar of Rome is celebrating a special mass for the bishop of Rome, John Paul II -- Alessio.

ALESSIO VINCI, CNN CORRESPONDENT: Hello, Miles.

As you can see behind me here, this mass is now over. And the thousands of pilgrims who were inside of the church, packed completely with just regular people, pilgrims, tourists and simply faithful who felt that they had to come here to pray for the pope.

John Paul II, as you mentioned, is, indeed, the bishop of Rome and the vicar for the pope here in Rome, Cardinal Camillo Ruini, celebrating this mass, which is now coming to an end.

We had a chance to speak earlier with several pilgrims and people coming out of the church, who are basically telling us that the mood in there is very somber but also extremely spiritual.

Obviously, the latest information that we're getting from the Vatican is certainly not encouraging as to regarding the pope's health.

And I'm going read this important statement that was issued only about an hour ago. "The general condition of the cardio-respiratory of the pope has worsened. There is a gradual worsening of the arterial hypertension" and has been noted the breathing has, basically, become shallow. The clinical picture, according to the Vatican statement, indicates cardio circulatory and renal insufficiency. The biological parameters are notably compromised. However, this statement issued but the Vatican, as I said, about an hour ago, ends by saying the pope with visible participation is enjoying the continual prayers of those assisting him, indicating, of course, it's a significant statement here that the pope remains conscious at this time, or at least as of about an hour ago.

And while the people here are leaving the cathedral, I can tell you that the entire city of Rome has pretty much fallen into a very somber mood. You can really tell by seeing the people's faces that there is a lot of sadness here, although, of course, the pope is not dead yet. But there is still a feeling, if you want, especially after this latest bulletin, that the pope is, indeed, in his final hours -- Miles.

O'BRIEN: Alessio, was this a mass that was previously scheduled, or was it specifically said for the pope?

VINCI: No, no. This is a mass that was specifically scheduled for the pope, for the pope. It is tradition -- tradition in the Catholic Church, of course, to hold masses.

At the end of the mass, by the way, there will be vigils, and people here in this area or around Rome and the pilgrims will be able to come here and pray and pray for the pope.

The same thing, of course, will be -- will be possible at different churches throughout Rome and, indeed, throughout the world. We have heard church leader, and not just Catholic Church leaders, around the world calling for prayers. This is a time of reflection. This is a time when the people really hope that, while they understand that perhaps there is no hope for the pope, at the same time, they feel that their prayer is helping the pope.

O'BRIEN: Alessio Vinci.

VINCI: Back to you.

O'BRIEN: Thank you. Alessio Vinci in Rome. And obviously, we'll be staying in close contact with him.

NGUYEN: And as we watch the pope's condition, as well, do stay with us. You're watching LIVE FROM as we have continuing coverage.

(COMMERCIAL BREAK)

NGUYEN: It has been almost eight hours since the unforgettable Vatican news conference where the pope's typically unflappable spokesman spoke through tears.

CNN's Jim Bittermann is at our bureau in -- on the fringe of Vatican City and joins us.

Obviously, that was a very telltale sign as to the condition of the pope.

JIM BITTERMANN, CNN CORRESPONDENT: A rather striking moment, a rather emotional moment for a lot of people in the press corps. In fact, the head of the Vatican press corps also broke down in tears as he was describing the pope's condition.

A lot of these people have worked around the pope for 26 years as is the case of Joaquin Navarro-Valls, the papal spokesman. And he was particularly struck, I think, as he began to talk about his personal relationship. There was a question about how he felt personally. And he choked up in tears.

It is a very moving moment for people who remember back when the pope started this pontificate, the kind of athletic and striking figure that the pope cut, a very handsome man, flying around the world, making speeches and attracting crowds everywhere he went.

And I was along on some of the trips. And when you see the pictures back then and compare them to the pope now, if you hadn't seen the pictures, you really wouldn't appreciate how different this pope was than previous popes that have taken over the chair of St. Peter's.

Now we're looking at some pictures, and I think you can see them of St. Peter's Square, where hundreds of people have gathered this evening. The two lights in the apostolic palace up there, the top floor, that's the papal apartments. The two lights were turned on shortly after sunset.

One thing I should say about that is we think that that may be significant, symbolizing that the pope is still alive. On the other hand, back some years ago when John XXIII died, the papal apartment lights were turned on to indicate that he had died.

Now, we have no indication that that is the case of the pope. In fact, we have every indication to the contrary right at the moment.

But we're certainly hearing some very negative things, including one of the things that Cardinal Ruini -- Alessio Vinci was mentioning the mass that was just said at St. John Lateran across town. Cardinal Ruini in part of that mass said that the pope already sees and touches the lord. He is already united with our soul savior.

Not very encouraging news from the cardinal vicar of Rome -- Betty.

NGUYEN: CNN's Jim Bittermann in Rome. Thank you for that, Jim.

Well, like no other place on earth, Vatican City is steeped in ritual mystery, even secrecy. And all of it jumps into high gear at times like this.

Delia Gallagher is a CNN Vatican analyst, and Delia, what can you tell us at this moment about what we know about the condition? It seems like everyone is looking for some kind of sign, since no official word has been said, except for the fact that the pope is not doing very well at this moment.

DELIA GALLAGHER, CNN VATICAN ANALYST: Well, actually, Betty, at the Vatican we are not used to the amount of information that we have received in the past few days.

At the beginning of the week, of course, there was interest in knowing exactly what the state of the pope's health was. But I have to say, by Vatican standards, they have given us an awful lot of information and very detailed information, at that, in the past 48 hours as regards the physical state of the pope's health -- Betty.

NGUYEN: Looking at the two windows right now, the windows where the pope's apartment, we just heard Jim Bittermann say that the fact that they're lit up speaks volumes. What does that say you to, Delia?

GALLAGHER: Well, we had a bit of an anomaly last night with the windows, because the windows -- the lights on in the pope's apartment signify that the pope is in the Vatican.

Now, last night it happened that when this crisis broke that the pope had a fever and a urinary tract infection, we noticed that the lights in the papal apartments were off. And this is something very strange and, in fact, it never happened before. And so we were considering last night whether that was a sign.

But I think we shouldn't read too much into lights on or lights off. We are getting the official information from the Vatican, which is that the pope is conscious but, obviously, grave. I think another interesting thing -- sorry, Betty.

NGUYEN: Delia, we're going to have to interrupt you right now, because we are learning from Reuters and the Italian media that Pope John Paul II has died. Again, this information is coming from Reuters and the Italian media that Pope John Paul II has died.

Of course, this is going to have lots of implications all around the world.

But Delia, you are there in Vatican City. Has this word spread to the crowds there?

GALLAGHER: No. I wouldn't say it's spread to anybody just yet. That's certainly the first I've heard of it and probably the first that many of the people around me have heard of it.

I will say that those are agency reports. So we do want to make sure that we have the official word from the Vatican. But those are reliable agency sources. And I do not think that they would put out -- put out that information if it were not true.

So we will probably have to double check that. But I think that that is probably the case -- Betty.

NGUYEN: All right, thank you, Delia Gallagher.

We want to go now to Miles O'Brien -- Miles.

O'BRIEN: CNN's Jim Bittermann is in Rome. He has been watching the story for us, as well. Have you heard anything officially, Jim? BITTERMANN: Nothing official. I'd just remind you that it was Reuters that, in fact, reported two days ahead of time that Yasser Arafat died. So I wouldn't put too much stock in into wire agency reports right at the moment. We'll get soon enough official announcements.

Back in 1978 when I was here for the death of Paul VI, the first real announcement came on RAI Television, a local television channel. We saw the vicar of Rome, in this case it would be Cardinal Ruini today, the vicar of Rome come out and make a taped statement.

So I think the official confirmation of that will have to wait until someone from the Vatican comes out and says it. There will be a lot of speculation. There's been speculation all day today. And a lot of people have said a lot of things. But we haven't been reporting them until we get some absolute confirmation from the Vatican.

O'BRIEN: All right. But just so our viewers understand, the sources that we're getting them from, Reuters and these Italian news agencies, have historically been pretty accurate. So we offer them up in the spirit that we do not have this independently confirmed officially from the Vatican press office.

And Jim, I think your guidance is good here. At the bottom here, though, we have to remind everybody that the steady stream of reports that have come out all day long have only led us down a worsening path of condition for Pope John Paul II, right?

BITTERMANN: No question about it, Miles. I mean, I don't think that there's any question that the pope is in the final stages of his life. I just think that it is a little premature to make announcements when we don't have confirmation from the Vatican.

And I think that the Vatican will make that confirmation a number of ways. For instance, they have an electronic system to signal journalists, Vatican accredited journalists on their cell phones. That system, so far as I know, hasn't been activated. I think Delia is one of those journalists, so she would be able to immediately tell us if her cell phone was lighting up.

The other thing that they have is they have this system through the official state television here, RAI, of making announcements. And that's another method of communication that they would use to signal the pope's death.

So I think, yes, I think the pope is dying. There's no question about that. All of his top churchmen say that and have said that throughout the day today. But I think perhaps the better part of dignity to sort of wait until we have some official announcement of it, rather than to report rumors.

O'BRIEN: All right. CNN's Jim Bittermann. Good guidance. Appreciate it. We'll be obviously staying in close contact with him -- Betty.

NGUYEN: We want to go back now to CNN's Vatican analyst, Delia Gallagher, who is there in Rome.

Delia, tell me what you know so far, because as we've been reporting, CNN has not independently confirmed this, but the Italian media and Reuters is reporting that Pope John Paul II has passed away. What do you know?

GALLAGHER: Well, Betty, as I understand it, Reuters is quoting Italian wire sources on that story. And as we have learned in the past few days, we need to be very careful before confirming those stories.

Now, how do you confirm that story? Well, in my opinion, you wait for the official Vatican statement, because it's not a story which deserves to be jumped with a scoop. It's simply not worth it. And so I think that the only way to confirm that outside of, obviously, there may be individual sources in the Vatican who could confirm that, but it is important that we wait for the official Vatican confirmation of that -- Betty.

NGUYEN: And as we wait for that confirmation, how do you think, if indeed this is the case, that word will be presented to the world, basically?

GALLAGHER: Well, what officially happens is -- or what is supposed to happen is this camerlengo (ph), who is the chamberlain, a Spanish cardinal, is supposed to officially pronounce to Cardinal Ruini, who is the cardinal saying mass at St. John Lateran (ph) at the moment, that the pope is dead. And Cardinal Ruini's job is to announce it to the world, either via Italian television or the radio.

So that is the official procedure. Now, how that will play out in these moments, I just don't know -- Betty.

NGUYEN: Do you think other symbols will be shown as well, because we're looking at a live picture right now of St. Peter's Square, where we do see the two lights still lit up in the pope's apartment.

GALLAGHER: Betty, I would not read anything into the lights in the pope's apartment. As I was explaining before, last night they were off; tonight they are on. Lights in the pope's apartment generally signify that the pope is in the Vatican. But we cannot read anything into whether the lights are on or off. It just wouldn't make sense for such an important and delicate story -- Betty.

NGUYEN: And as we wait for that word, a lot of people are questioning, especially with the pope being so gravely ill, why did he stay there? Why did he not go back to Gemelli Hospital? Why is that?

GALLAGHER: Well, I think one of the things that people don't realize about this pope is that he has always made his own decisions. There is a sort of myth that there are people behind the pope deciding things for him, deciding that he should go to the window, deciding he should go on papal trips. But the papal spokesman today even confirmed for us that the pope himself asked, can I receive adequate care here in the Vatican? And I think it's understandable that the pope would like to spare himself, another trip to the hospital, which would only be necessary in the case of a major operation. So I think it's perfectly understandable that the pope would have made that decision, to stay at the Vatican, where he has lived for the past 26 years.

NGUYEN: All right, we're going to ask you to stand by, Delia Gallagher, a CNN Vatican analyst. We're going to toss it over to Miles right now.

O'BRIEN: Let's bring in Dr. Sanjay Gupta, our senior medical correspondent here.

Sanjay, that Reuters report which we've been talking about -- and we're not trying to jump the gun here. Let's just talk about the kind of progression here, which appears to be inevitable. What they say is the electrocardiogram has gone flat. That seems, for a layman, to mean the end. But why don't you just interpret that for us.

DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Yes, that is definitive. What we're looking to determine whether someone has, in fact, died or not is whether or not there is still a heartbeat remaining. Typically, you can put a stethoscope on the chest and listen for a minute, or you can do an EKG, which is actually measuring the electrical tracings of the heart. If that is, in fact, flat, then the pope has passed away.

O'BRIEN: All right, there was another report we saw come across the wires, which came from a Mexican prelat (ph), who said, the pope was in agony. That was the term. And I something may have gotten lost in translation there. Why don't you explain that as well.

GUPTA: Yes, there's something that's well known, especially in terminal, patients called agonal respirations. And this is end of life type of respirations. It does not imply that the patient, or person, is in any pain, or there's anything going on besides the fact that there is some labored breathing, which is very consistent with someone who is at the end of their life, in this case, because of the sepsis, which is the infection throughout the body. The body often responds by quick, labored breathing.

O'BRIEN: And let's explain that infection, how that infection has spread and what its implications are to the human body.

GUPTA: We first heard that in fact yesterday, almost 20 hours ago now, that he had a drop in his blood pressure, which is some of the first signs of a body-wide infection. Then it was isolated to the urinary tract. What has probably happened here, Miles, and this isn't uncommon in this age group -- is the bacteria in the bladder, or the kidneys, actually spread into the bloodstream, and started to make its way around the body. That is what septic shock is. What it can cause is a collapse of the cardiac, the heart, as well as all the other blood vessels.

O'BRIEN: So when you say septic shock, is that almost always the end? Is that a terminal condition, or can, you know, with concerted treatment, can somebody be brought back from septic shock? GUPTA: Someone could be brought back from septic shock, although given his age and his preexisting medical conditions -- we did our homework on this -- even in the intensive care unit with the best sort of care -- IV, antibiotics, medications to raise your blood pressure and help your heart. Even with all that, about a 20 percent survival from the full-blown episode of septic shock.

O'BRIEN: And of course, the pope has chosen to remain in his apartment, where of course there is quite an array of medical capability. But we're not talking about necessarily an intensive care unit.

GUPTA: That's right. I don't know what the capabilities are in the Vatican. They seem like they're quite good, but I don't think they're an intensive-care unit.

O'BRIEN: Let's just back up for just a moment and put this all under the big picture of his sort of preexisting health condition, Parkinson's and all the other things and kind of walk us through the progression that we've seen -- we've witnessed here.

GUPTA: Yes, first of all, his general health, obviously, very poor. The Parkinson's, significant arthritis, which is relevant because he was immobile as a result of this arthritis. He'd been shot. Everyone knows that as well. He seemed to have a general decline of health conditions after that assassination attempt.

With the Parkinson's, we hear, you know, some difficulty with the breathing. He was in the hospital for 10 days in February, and then back in the hospital less than two weeks after that for this breathing tube. My impression is he never fully recovered from that initial hospitalization two months ago to the day now.

O'BRIEN: And it's interesting, when you get to be an octogenarian, there is a cascade effect, isn't there, the dominoes just kind of start to fall, don't they?

GUPTA: Absolutely. The flu-like symptoms 10 days, a breathing tube, followed by a feeding tube, followed by a fever, low blood pressure, septic shock, and now we're hearing about his heart as well.

O'BRIEN: You know, it's interesting as we look, by the way, at the light on at the papal apartment there in Vatican City, it's interesting you mention the shooting. That's not often plugged into the picture here, because he was so vital. He seemed to have a full recovery, and this is we're talking 1981. And most of our history with the pope were very vital days subsequent to that shooting. And yet there are lingering effects that perhaps we haven't seen all these years.

GUPTA: And I don't profess to know his entire medical history. But I have talked to a lot of doctors about him. And doctors have commented, since that time, he seemed to have a very slow, but progressive, gradual decline in health. In now way is nobody saying that Parkinson's Disease is a result of the assassination attempt, but he did seem to have a gradual decline after that. O'BRIEN: Interesting, Parkinson's also, there's kind of a vicious cycle here between the infection and Parkinson's. The Parkinson's makes the infection likely, the infection makes the Parkinson's worse and so forth. Explain that.

GUPTA: Absolutely. It is a vicious cycle. Just because of the immobility, Parkinson's Disease doesn't actually suppress your immune system in any way, but because of your immobility, you're more likely to develop infections.

When I heard about fever yesterday, I thought it was going to be a pneumonia. That's actually a more common fever source than the urinary-tract infection. But then once the infection has set in, it actually makes the Parkinson's symptoms worse as well. So it's sort of a vicious cycle. Someone who has worsening Parkinson's symptoms can seem even more lethargic, even more immobile. All of that might be moot at this point, given how significant his sepsis is.

O'BRIEN: Is this a not unusual demise then, for someone with Parkinson's to have this kind of effect?

GUPTA: Yes, this is common, to have some sort of infection that gradually seeps in the body.

O'BRIEN: Sanjay Gupta, thank you very much, learned a lot. Appreciate it.

Jim Bittermann is in Rome.

And, Jim, tremendous experience covering the Vatican through these times. Jim, I'm just curious, in this day in age, how the release of information compares to what you experienced nearly 30 years ago now?

JIM BITTERMANN, CNN CORRESPONDENT: Well, one of the things, Miles is the incredible media exposure this time around. I mean, back then, we were still recording on film, and we had to put up with satellites that occasionally passed overhead that you could bounce the signal up for a few minutes each hour. So I mean, there was a lot less communication capability than there is today.

I think one of the things that will change things in the way we cover the next few days and weeks here, as this papal transition takes place, if in fact it does, is that the communication will be much different than it was back then.

Back then, of course, it was just Rye (ph) Television. That was the only state channel that was putting out news here. We're getting a lot of news this evening from a lot of different media outlets, and media sources in Rome and in Italy.

So it's changed the picture completely. The other thing that will happen, too, is that we'll see coming to Rome just an incredible number of people, not only from the media. We're going to see, I think, coming a number of different strands of the Catholic Church, who want to be represented here as this very important job takes place, this very important job of picking a successor. You'll see people coming from various Christian movements, various Catholic movements around the world who want to, in a sense, lobby the cardinals in a way that didn't take place back in 1978 -- Miles.

O'BRIEN: Well, that would be an interesting thought, to think about lobbying a conclave, which of course is not the thing that is subject to lobbying.

Interesting thing here, I thought. Well, go ahead if you want to amplify on that, Jim.

BITTERMANN: No, I was just going to say that the sense of the conclave is complete lockdown. I mean, there's nobody allowed to talk to the cardinals inside the convent. What I'm saying is in that period of time between the pope's death and the beginning of the conclave, there's a 15-day period in there, in which mourning for the pope takes place and various congregation takes place. These days it will be completely different. For one thing, these cardinals all carry cell phones nowadays. Back then, there no cell phones around. You would have to go across town and meet somebody for coffee or whatever. These day you can put together a cell phone network, you can send out SMS messages -- you can do all sorts of things if you wanted to communicate directly to the cardinals and you knew their cell phone numbers.

O'BRIEN: Well, it's a long way from St. Peter's when you start talking about SMS messages for the next pontiff, potentially. Let me ask you this, Jim. It seemed as if the Vatican press office, just reading the tea leaves here, was very deliberate in announcing today that the pope had appointed 17 new bishops and archbishops, accepted the resignation of six other archbishops. That little piece of news is symbolic in many senses, isn't it?

BITTERMANN: It is in a lot of ways. For one thing, those bishops' names and the resignations would all have to be approved by the pope. That's the church rules. You can't become a bishop unless the pope chooses you as a bishop. At some point along the line, the pope had to approve those names. Now, whether that took place today or not, we just don't know. It was certainly announced today. Whether the pope made his decisions today, we just don't know.

But it could be taken two ways. Either the Vatican wanted to show that the work of the church was still going, or, perhaps, the Vatican is wanting to get its house in order before a papal passing. It would be completely impossible for the Vatican to announce the names of bishops after they had announced that the pope had died.

O'BRIEN: And while we're talking about that -- we talked about the media's presence there. Once again, live pictures now. That's the papal apartment, with the lights still blaring. We've talked about the amount of media attention. Let's talk about how much more information, relatively speaking, the Vatican is providing the media at this time. This is not something that -- it's not a forthcoming outfit, is it?

BITTERMANN: Well, this is something that changed literally overnight. I don't know if you remember just a few weeks ago, when we were standing outside of Gemelli Hospital, hoping we'd get some kind of information about what the pope's condition was. In fact, that all changed in the last 24 hours.

The Vatican came forward with incredible amounts of information about the exact papal condition, some of it shepherded by a doctor himself. That's the doctor Joaquin Navarro-Valls. The papal spokesman is also a medical doctor, and sometimes his medical bulletins reflected that because they were pretty technical.

I think, you know, maybe, though, it was a sense that there was no point in further spinning it in a positive way and further making it look like things were going on as normal or trying to make it look like things were going on as normal. Just a need to sort of inform the world's Catholics. I mean, this is the age of the 24-hour news network. It's a different age than it was back in 1978, the last time there was a papal transition.

O'BRIEN: Yes. And you know, it's worth pointing out the church can be slow to change. But they are also well plugged into the realities of leadership here and exactly how these things unfold and how, in order to lead the faithful. Jim Bittermann, thank you very much. Stay close.

CNN's Alessio Vinci is back with us. Alessio, what can you tell us?

ALESSIO VINCI, CNN ROME BUREAU CHIEF: Hello, Miles. Well, if, indeed, the pope were dead, the person who is in charge of announcing his death to Rome is the vicar of the pope for Rome. As you know, the pope is the bishop of Rome. His vicar, Cardinal Camillo Ruini, would be the person in charge of announcing to the Roman people that the pope has died.

Cardinal Camillo Ruini has just finished celebrating a mass here in San Giovanni Leterrano (ph). Thousands of people have just left this building, most of them unaware of this latest report from an Italian news agency that the pope has died. I think that nobody really here is ready to confirm this piece of information officially. We have not heard from Cardinal Camillo Ruini. It would not be unusual for the cardinal, if this information would have been correct, to actually say something, perhaps at the end of the mass.

I can also tell you that right next to me there are several positions of Italian state television (INAUDIBLE). That is also a means through which Cardinal Ruini could, in theory, announce to the people of Rome and indeed, to the people of Italy that the pope has died. So all this is not happening at this time.

Unfortunately, I don't know exactly whether Cardinal Ruini is still inside the cathedral or whether he has left already, but I can tell you that at the end of this mass, there was no mention of the fact that the pope had died, basically.

O'BRIEN: All right, Alessio.

VINCI: Back to you -- Miles.

O'BRIEN: Just to follow up on that, we, of course -- we've been telling our viewers about reports on Reuters quoting some Italian news agencies that the electrocardiogram may, in fact, have gone flat. We do not have any independent verification of that.

And Alessio, what you're alluding to you here is, over the years, we have been told of these things in a very formal, symbolic way, in many ways. Doors opened or shut, shutters shut. That kind of thing. In this case, in day and age, it may not happen that way in this day and age, will it?

VINCI: That is correct. I mean, even in the old days, even the way the pope's death was being certified, you had the Cardinal Camerlengo (ph) tapping with a silver hammer on his forehead, calling his baptismal name. We're not necessarily sure that this is happening again this time around. Actually, that procedure was probably eliminated with John the 23rd, I believe. So, obviously, modern medicine has different ways to discern whether a person is dead or not.

Certainly, all these indications of the lights on, lights off, we can't really read anything into it. Last night, for example, when the Vatican announced the pope actually had a high fever and had infection to his urinary tract, as well as being on antibiotics, the lights of his Apostolic Palace was switched off. And, you know, we couldn't even really understand why.

So these are all, if you want, small elements that perhaps are just at this time in the evening and, there's obviously a lot of confusion here in Rome at this time. A lot of speculation about what is really happening, perhaps. You know, it could also mean that a person may have forgotten, you know, to turn the switch on or to pull a curtain or whatever.

Regarding the Italian media report about the electrocardiogram, Miles, I need to be very specific about this, because the Italian media -- the Italian agency was reporting this, in Italian, of course, is not talking about an electrocardiogram. They are talking about what is known as an EEG, which is a machine that monitors brain activity.

So if, indeed, this Italian agency is right -- and we have not been able to confirm this, so we're not telling you this is the case. If, indeed, this Italian agency is correct, what they're talking about is cerebral activity being basically zero, not his heart.

So this is a very, you know, distinction that I would like to make. Because there have some problems with the translation here. But it is -- the Italian news agency here is talking about his cerebral activity, not his heart.

O'BRIEN: All right, Alessio. This is where it becomes very convenient to have a doctor on call and at the ready at all times. Dr. Gupta, walk us through the EEG, the significance of -- essentially, brain wave activity ceasing. GUPTA: That's right. And Alessio's exactly right on this. The EKG is actually monitoring your heart activity, whereas the EEG is monitoring the brain activity. Very different, obviously, not just in terms of the organs that they're measuring, in terms of the activity, but also in terms of the significance.

EEG and brain death is something that we've defined more recently, within the last 40 years or so, actually being able to say someone is brain dead. Their brain will not recover. This is -- this became a more accurate description for people who are considering organ donation, for example. EKG, measuring the heart activity, is what is used as the criteria for actual death, versus brain death.

O'BRIEN: So that remains sort of the official threshold between life and death, is the functioning of the heart?

GUPTA: The functioning of the heart, either by EKG or, as we were talking about, someone actually putting a stethoscope and listening for any heart activity for a full minute. If there is no heart activity, that is also a criteria to pronounce someone dead.

O'BRIEN: All right, and you know, I can't help but hearken back to what we've been talking about all this past week with Terri Schiavo, where the thresholds of life and death lie. Medicine gives us so much. Modern medicine gives us so many capabilities and really makes it very difficult to define that moment, doesn't it?

GUPTA: It does. And there's several different conditions, as well. For example, the person who is being examined cannot have any medications that might make their heart slow. They cannot be -- have a cold temperature, for example, that might make their heart slow. So if those criteria are met and someone doesn't have any electrical heart activity, then it's fair and consistent around the world to pronounce them dead. But you know, with the EEG alone, this is just a brain death. The heart could still be beating, the organs could still be functioning, even with the brain death EEG.

O'BRIEN: And of course, we really don't know what the pope's wishes were in these final moments. You know, we've talked about living wills a lot, as well. And it's difficult for us to understand, except on the face of it, he did make that decision to stay home. And that is telling, isn't it?

GUPTA: It is telling. And let me make it a little bit more confusing, which I don't mean to do, but if someone, in fact, has a brain death EEG, but their heart is still beating, then almost by definition, they are requiring a mechanical breathing machine, OK? You see what I'm getting at here.

O'BRIEN: Yes, I do.

GUPTA: So if someone is brain dead but still has a functioning heart, the only way that could still be happening is with a breathing machine. And I don't know that the pope's on a breathing machine, but if those two things are accurate, then he would almost have to be. O'BRIEN: Interesting to ponder at this moment. Yet another thing we don't know as we consider what is obviously the final moments of John Paul II. Sanjay Gupta, thanks very much -- Betty.

NGUYEN: And speaking of what we don't know, let's be very clear right now that Italian media gave contradictory reports, first saying that the pope had passed away, now saying that that is not the case. At first they said his heart and his brain activity had stopped. Now, Italian media is reporting that is not true.

We want to get some clarification now, and for that, let's go to CNN Vatican Analyst Delia Gallagher, who is there in Rome. Delia, what are you learning at this moment?

GALLAGHER: Well, Betty, we've got exactly what you've just reported, which is that Italian wire report. In a sense we are still very calm here on the ground because, if you've worked at the Vatican for a while, you understand, in particular, with this story, there is huge anxiousness and a sort of freneticism to get the latest news.

Now, that's considered part and parcel of journalists at work these days. But at the Vatican, I think that is increased in some way because the Vatican generally doesn't respond to news reports. This is, obviously, a very different case, but in the past, journalists have been a bit spoiled, perhaps, in their ability to throw out some stories without getting an immediate response or denial from the Vatican.

So there is a very particular working situation here for journalists at the Vatican who, obviously, have to be very careful with the delicate story, but at the same time, would like to try and arrive first, in a sense. But they need to get it right.

Betty.

NGUYEN: And that is key, to get it right. And again, we want to be very clear that CNN has not made confirmation that Pope John Paul II has passed away. In fact, Italian media reported that just a little bit earlier, but has now said that that is not the -- is not true. And the Vatican was also quoted as saying that both the pope's brain and heart were still functioning. Talk to me a little bit, Delia, about who might be with the pope at this hour.

GALLAGHER: Well for sure there is his private secretary, a man who is behind the scenes and doesn't get any publicity, but those of us at the Vatican know him very well. He's Don Stanislaw Dziwisz. He has been the private secretary of the pope for 40 years and his closest adviser and friend. He is the man that you go through if you would like to see the pope. So he is a very at once powerful, but he is a very kind and compassionate man, and has certainly been at this pope's side throughout his pontificate and even before in Poland.

There are obviously, a few aides that help Don Stanislaw with the pope, as well as several Polish nuns who run the household.

And clearly at this time, there will be medical doctors. We know earlier today that four top Vatican cardinals went to visit the pope, one of whom an American, Cardinal Shulka (ph). He is from Detroit, and he is the governor of the Vatican city-state, an important cardinal here at the Vatican.

So there has been some activity. At this moment we do not know who is in the room with him, but surely, those closest aides are with him.

NGUYEN: CNN's Delia Gallagher there in Rome for us. Delia, stand by. We'll be coming back to you shortly. Miles.

O'BRIEN: Catholics all around the world have their attention focus on this very this event, more than a billion of them, 60 million of them here in the United States. Among the places that is are focuses of attention, of course the cathedrals and churches all around our nation. CNN's Joe Johns joins us from Washington at just such a place, where many of the faithful are coming to say a few prayers for Pope John Paul II at this moment -- Joe.

JOE JOHNS, CNN CORRESPONDENT: Miles, this is the Cathedral of St. Matthew in downtown Washington. Archbishop Theodore McCarrick, this is his home church. We've be following him throughout the morning, as you know. He said a mass earlier today. This sort of gives us a window on how at least some of the cardinals are getting information. He is very frank about the fact that he is watching television to try to get word on the pope's condition. He does also expect to get a news from Rome. But quite frankly, he's watching TV, he's watching the media.

We're told just a little while ago, he did leave the cathedral here to go back to his office, where he said he'll wait for word there. But as much as everyone else, he's watching electronic media to try to find out what's going on -- Miles.

O'BRIEN: Yeah, Cardinal McCarrick had some very interesting things to say just a little while ago, right before we came on the air. And I want to throw this one thing at you. He said that John Paul II was, in a way, American. He liked people. He was humble. Pardon me for that past tense there, but I'm just quoting the cardinal there. Therefore, we became close to him. It was an interesting point, don't you think?

JOHNS: Yeah, interesting point. Also, he said that, in his view, one of the things that made him so popular in the United States was his connection with young people around the world. And he felt that that is at least part of the reason why John Paul was so well known and well liked throughout the United States. Clearly, though, he also said during the mass just a little while ago that there were times when John Paul would surprise the people who worked with him, meaning the other cardinals, by taking on certain issues that they weren't all clear which direction he was going to go on. So just a testament, I think, to an extraordinary man, the pope, whether, of course, he lives or dies right now.

O'BRIEN: Yeah. You mention a really interesting point as we look at live pictures from the Vatican as the faithful gather together there. In so many ways, John Paul II was just the right man at the right time to serve in that papacy -- the first real full-fledged television-age pope. Really had a way of connecting with people at that level, didn't he?

JOHNS: Well, certainly, it's true. And another point that was made today by Archbishop McCarrick is that even now, when the pope is apparently at the end of his life, he finds himself setting an example -- an example, they say, of how to die, and suffering. A lot of people I've spoken to here again and again have said, in suffering, there's a certain amount of dignity. And they say that is what he's showing at this time, Miles.

O'BRIEN: Joe Johns in Washington with the faithful there, gathering as they are all over the world right now, as you see live pictures in St. Peter's Square. A lot of somber faces. A lot of prayers being said right this moment for John Paul II.

Thank you, Joe -- Betty.

NGUYEN: We want to go now to CNN's Jim Bittermann, who is in Rome. And Jim, we are looking at these live pictures of so many people gathered in St. Peter's Square. Obviously, the mood is a very somber one.

BITTERMANN: Absolutely, Betty. And in fact, one of the things that we expect to happen here just in the next few minutes is Cardinal Camillo Ruini, the vicar of Rome, who was just delivering a mass and celebrating mass over at St. John Laderan Church, is going to come here to St. Peter's Square and lead the crowds and lead the faithful in the rosary, a rosary dedicated to Pope John Paul II.

As these people gather, one of the things that's been kind of unfocused for a lot of the faithful is exactly where to go and what to do. Where should you go? Will we get anything that would resemble activity out of the Vatican? And one of the reasons why Cardinal Ruini has chosen to conduct these rosaries tonight is to -- and lead the crowd through these rosaries I think is that it will help the faithful, bring them together with the pope at this hour.

NGUYEN: Jim, we reported earlier that Italian media was having a lot of different reports out there about the pope's condition. Well, we have just learned that the Associated Press is saying that the Vatican has denied reports that Pope John Paul II has died. Now, you had mentioned Cardinal Ruini would be coming out shortly to lead in a rosary. Do you expect any kind of statement from him as to the pope's condition?

JOHNS: No, we don't. And I don't think that would sort of be the way things would take place. It's conceivable, of course. This has been a very surprising day, in many ways. So I think anything could happen. But -- and it is Cardinal Ruini who is charged with the responsibility of announcing the pope's death. Having said that, we understood from the Vatican press office that, in fact, he's going to just lead the crowds in rosaries.

And I should say there have been rumors flying around the Vatican all day long, all night last night, as a matter of fact, about the pope's death, about his condition -- exact condition, and all that sort of things. A lot of them have been disproved over the hours that have followed. So I don't think we want to put too much stock in the kind of rumors that are coming around.

There's an awful lot being said. We know that the pope is dying. The papal spokesman has made that clear. In fact, Cardinal Ruini himself this evening in the mass said, "The pope already sees and touches the Lord. He's already united with our Soul Savior." So not a very optimistic accounting there from Cardinal Ruini himself. But I think that's the kind of thing we have to follow for guidance rather than the Italian press story.

NGUYEN: And it's words like that, obviously, that in times like this really brings, I guess, some solace to people as they're watching the pope and his ailing health.

BITTERMANN: Yes, that's right. I think -- I think one of the things that was clear, too, in what has been said is that the Vatican believes that by showing the pope suffering they are setting an example and symbolically showing Christians not only have to live but, as Cardinal McCarrick said a little while ago, showing them not only how to live, but also how to die -- Betty.

NGUYEN: Jim Bittermann, we're going to ask you to stand by. We'll be checking in shortly. Thank you for that -- Miles.

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Aired April 1, 2005 - 13:15   ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
BETTY NGUYEN, CO-HOST: Thank you, Wolf. I'm Betty Nguyen in for Kyra Phillips today.
MILES O'BRIEN, CO-HOST: And I'm Miles O'Brien.

It is about 8:15 in the evening at the Vatican. The sun has set on what appears to be a fateful day in the life of the Roman Catholic Church and all around the world. It's already been a trying day, with Pope John Paul II's already grave medical condition said to be further deteriorating.

A worshiper in Saint -- John Paul's native Poland seemed to speak for Catholics everywhere when she told a reporter, "I want him to hold on, to hold on, but it's in God's hands now."

Our coverage this hour begins with CNN's Alessio Vinci and Jim Bittermann, both of them in Rome. Alessio is at the Cathedral of St. John Lateran, where the vicar of Rome is celebrating a special mass for the bishop of Rome, John Paul II -- Alessio.

ALESSIO VINCI, CNN CORRESPONDENT: Hello, Miles.

As you can see behind me here, this mass is now over. And the thousands of pilgrims who were inside of the church, packed completely with just regular people, pilgrims, tourists and simply faithful who felt that they had to come here to pray for the pope.

John Paul II, as you mentioned, is, indeed, the bishop of Rome and the vicar for the pope here in Rome, Cardinal Camillo Ruini, celebrating this mass, which is now coming to an end.

We had a chance to speak earlier with several pilgrims and people coming out of the church, who are basically telling us that the mood in there is very somber but also extremely spiritual.

Obviously, the latest information that we're getting from the Vatican is certainly not encouraging as to regarding the pope's health.

And I'm going read this important statement that was issued only about an hour ago. "The general condition of the cardio-respiratory of the pope has worsened. There is a gradual worsening of the arterial hypertension" and has been noted the breathing has, basically, become shallow. The clinical picture, according to the Vatican statement, indicates cardio circulatory and renal insufficiency. The biological parameters are notably compromised. However, this statement issued but the Vatican, as I said, about an hour ago, ends by saying the pope with visible participation is enjoying the continual prayers of those assisting him, indicating, of course, it's a significant statement here that the pope remains conscious at this time, or at least as of about an hour ago.

And while the people here are leaving the cathedral, I can tell you that the entire city of Rome has pretty much fallen into a very somber mood. You can really tell by seeing the people's faces that there is a lot of sadness here, although, of course, the pope is not dead yet. But there is still a feeling, if you want, especially after this latest bulletin, that the pope is, indeed, in his final hours -- Miles.

O'BRIEN: Alessio, was this a mass that was previously scheduled, or was it specifically said for the pope?

VINCI: No, no. This is a mass that was specifically scheduled for the pope, for the pope. It is tradition -- tradition in the Catholic Church, of course, to hold masses.

At the end of the mass, by the way, there will be vigils, and people here in this area or around Rome and the pilgrims will be able to come here and pray and pray for the pope.

The same thing, of course, will be -- will be possible at different churches throughout Rome and, indeed, throughout the world. We have heard church leader, and not just Catholic Church leaders, around the world calling for prayers. This is a time of reflection. This is a time when the people really hope that, while they understand that perhaps there is no hope for the pope, at the same time, they feel that their prayer is helping the pope.

O'BRIEN: Alessio Vinci.

VINCI: Back to you.

O'BRIEN: Thank you. Alessio Vinci in Rome. And obviously, we'll be staying in close contact with him.

NGUYEN: And as we watch the pope's condition, as well, do stay with us. You're watching LIVE FROM as we have continuing coverage.

(COMMERCIAL BREAK)

NGUYEN: It has been almost eight hours since the unforgettable Vatican news conference where the pope's typically unflappable spokesman spoke through tears.

CNN's Jim Bittermann is at our bureau in -- on the fringe of Vatican City and joins us.

Obviously, that was a very telltale sign as to the condition of the pope.

JIM BITTERMANN, CNN CORRESPONDENT: A rather striking moment, a rather emotional moment for a lot of people in the press corps. In fact, the head of the Vatican press corps also broke down in tears as he was describing the pope's condition.

A lot of these people have worked around the pope for 26 years as is the case of Joaquin Navarro-Valls, the papal spokesman. And he was particularly struck, I think, as he began to talk about his personal relationship. There was a question about how he felt personally. And he choked up in tears.

It is a very moving moment for people who remember back when the pope started this pontificate, the kind of athletic and striking figure that the pope cut, a very handsome man, flying around the world, making speeches and attracting crowds everywhere he went.

And I was along on some of the trips. And when you see the pictures back then and compare them to the pope now, if you hadn't seen the pictures, you really wouldn't appreciate how different this pope was than previous popes that have taken over the chair of St. Peter's.

Now we're looking at some pictures, and I think you can see them of St. Peter's Square, where hundreds of people have gathered this evening. The two lights in the apostolic palace up there, the top floor, that's the papal apartments. The two lights were turned on shortly after sunset.

One thing I should say about that is we think that that may be significant, symbolizing that the pope is still alive. On the other hand, back some years ago when John XXIII died, the papal apartment lights were turned on to indicate that he had died.

Now, we have no indication that that is the case of the pope. In fact, we have every indication to the contrary right at the moment.

But we're certainly hearing some very negative things, including one of the things that Cardinal Ruini -- Alessio Vinci was mentioning the mass that was just said at St. John Lateran across town. Cardinal Ruini in part of that mass said that the pope already sees and touches the lord. He is already united with our soul savior.

Not very encouraging news from the cardinal vicar of Rome -- Betty.

NGUYEN: CNN's Jim Bittermann in Rome. Thank you for that, Jim.

Well, like no other place on earth, Vatican City is steeped in ritual mystery, even secrecy. And all of it jumps into high gear at times like this.

Delia Gallagher is a CNN Vatican analyst, and Delia, what can you tell us at this moment about what we know about the condition? It seems like everyone is looking for some kind of sign, since no official word has been said, except for the fact that the pope is not doing very well at this moment.

DELIA GALLAGHER, CNN VATICAN ANALYST: Well, actually, Betty, at the Vatican we are not used to the amount of information that we have received in the past few days.

At the beginning of the week, of course, there was interest in knowing exactly what the state of the pope's health was. But I have to say, by Vatican standards, they have given us an awful lot of information and very detailed information, at that, in the past 48 hours as regards the physical state of the pope's health -- Betty.

NGUYEN: Looking at the two windows right now, the windows where the pope's apartment, we just heard Jim Bittermann say that the fact that they're lit up speaks volumes. What does that say you to, Delia?

GALLAGHER: Well, we had a bit of an anomaly last night with the windows, because the windows -- the lights on in the pope's apartment signify that the pope is in the Vatican.

Now, last night it happened that when this crisis broke that the pope had a fever and a urinary tract infection, we noticed that the lights in the papal apartments were off. And this is something very strange and, in fact, it never happened before. And so we were considering last night whether that was a sign.

But I think we shouldn't read too much into lights on or lights off. We are getting the official information from the Vatican, which is that the pope is conscious but, obviously, grave. I think another interesting thing -- sorry, Betty.

NGUYEN: Delia, we're going to have to interrupt you right now, because we are learning from Reuters and the Italian media that Pope John Paul II has died. Again, this information is coming from Reuters and the Italian media that Pope John Paul II has died.

Of course, this is going to have lots of implications all around the world.

But Delia, you are there in Vatican City. Has this word spread to the crowds there?

GALLAGHER: No. I wouldn't say it's spread to anybody just yet. That's certainly the first I've heard of it and probably the first that many of the people around me have heard of it.

I will say that those are agency reports. So we do want to make sure that we have the official word from the Vatican. But those are reliable agency sources. And I do not think that they would put out -- put out that information if it were not true.

So we will probably have to double check that. But I think that that is probably the case -- Betty.

NGUYEN: All right, thank you, Delia Gallagher.

We want to go now to Miles O'Brien -- Miles.

O'BRIEN: CNN's Jim Bittermann is in Rome. He has been watching the story for us, as well. Have you heard anything officially, Jim? BITTERMANN: Nothing official. I'd just remind you that it was Reuters that, in fact, reported two days ahead of time that Yasser Arafat died. So I wouldn't put too much stock in into wire agency reports right at the moment. We'll get soon enough official announcements.

Back in 1978 when I was here for the death of Paul VI, the first real announcement came on RAI Television, a local television channel. We saw the vicar of Rome, in this case it would be Cardinal Ruini today, the vicar of Rome come out and make a taped statement.

So I think the official confirmation of that will have to wait until someone from the Vatican comes out and says it. There will be a lot of speculation. There's been speculation all day today. And a lot of people have said a lot of things. But we haven't been reporting them until we get some absolute confirmation from the Vatican.

O'BRIEN: All right. But just so our viewers understand, the sources that we're getting them from, Reuters and these Italian news agencies, have historically been pretty accurate. So we offer them up in the spirit that we do not have this independently confirmed officially from the Vatican press office.

And Jim, I think your guidance is good here. At the bottom here, though, we have to remind everybody that the steady stream of reports that have come out all day long have only led us down a worsening path of condition for Pope John Paul II, right?

BITTERMANN: No question about it, Miles. I mean, I don't think that there's any question that the pope is in the final stages of his life. I just think that it is a little premature to make announcements when we don't have confirmation from the Vatican.

And I think that the Vatican will make that confirmation a number of ways. For instance, they have an electronic system to signal journalists, Vatican accredited journalists on their cell phones. That system, so far as I know, hasn't been activated. I think Delia is one of those journalists, so she would be able to immediately tell us if her cell phone was lighting up.

The other thing that they have is they have this system through the official state television here, RAI, of making announcements. And that's another method of communication that they would use to signal the pope's death.

So I think, yes, I think the pope is dying. There's no question about that. All of his top churchmen say that and have said that throughout the day today. But I think perhaps the better part of dignity to sort of wait until we have some official announcement of it, rather than to report rumors.

O'BRIEN: All right. CNN's Jim Bittermann. Good guidance. Appreciate it. We'll be obviously staying in close contact with him -- Betty.

NGUYEN: We want to go back now to CNN's Vatican analyst, Delia Gallagher, who is there in Rome.

Delia, tell me what you know so far, because as we've been reporting, CNN has not independently confirmed this, but the Italian media and Reuters is reporting that Pope John Paul II has passed away. What do you know?

GALLAGHER: Well, Betty, as I understand it, Reuters is quoting Italian wire sources on that story. And as we have learned in the past few days, we need to be very careful before confirming those stories.

Now, how do you confirm that story? Well, in my opinion, you wait for the official Vatican statement, because it's not a story which deserves to be jumped with a scoop. It's simply not worth it. And so I think that the only way to confirm that outside of, obviously, there may be individual sources in the Vatican who could confirm that, but it is important that we wait for the official Vatican confirmation of that -- Betty.

NGUYEN: And as we wait for that confirmation, how do you think, if indeed this is the case, that word will be presented to the world, basically?

GALLAGHER: Well, what officially happens is -- or what is supposed to happen is this camerlengo (ph), who is the chamberlain, a Spanish cardinal, is supposed to officially pronounce to Cardinal Ruini, who is the cardinal saying mass at St. John Lateran (ph) at the moment, that the pope is dead. And Cardinal Ruini's job is to announce it to the world, either via Italian television or the radio.

So that is the official procedure. Now, how that will play out in these moments, I just don't know -- Betty.

NGUYEN: Do you think other symbols will be shown as well, because we're looking at a live picture right now of St. Peter's Square, where we do see the two lights still lit up in the pope's apartment.

GALLAGHER: Betty, I would not read anything into the lights in the pope's apartment. As I was explaining before, last night they were off; tonight they are on. Lights in the pope's apartment generally signify that the pope is in the Vatican. But we cannot read anything into whether the lights are on or off. It just wouldn't make sense for such an important and delicate story -- Betty.

NGUYEN: And as we wait for that word, a lot of people are questioning, especially with the pope being so gravely ill, why did he stay there? Why did he not go back to Gemelli Hospital? Why is that?

GALLAGHER: Well, I think one of the things that people don't realize about this pope is that he has always made his own decisions. There is a sort of myth that there are people behind the pope deciding things for him, deciding that he should go to the window, deciding he should go on papal trips. But the papal spokesman today even confirmed for us that the pope himself asked, can I receive adequate care here in the Vatican? And I think it's understandable that the pope would like to spare himself, another trip to the hospital, which would only be necessary in the case of a major operation. So I think it's perfectly understandable that the pope would have made that decision, to stay at the Vatican, where he has lived for the past 26 years.

NGUYEN: All right, we're going to ask you to stand by, Delia Gallagher, a CNN Vatican analyst. We're going to toss it over to Miles right now.

O'BRIEN: Let's bring in Dr. Sanjay Gupta, our senior medical correspondent here.

Sanjay, that Reuters report which we've been talking about -- and we're not trying to jump the gun here. Let's just talk about the kind of progression here, which appears to be inevitable. What they say is the electrocardiogram has gone flat. That seems, for a layman, to mean the end. But why don't you just interpret that for us.

DR. SANJAY GUPTA, CNN SR. MEDICAL CORRESPONDENT: Yes, that is definitive. What we're looking to determine whether someone has, in fact, died or not is whether or not there is still a heartbeat remaining. Typically, you can put a stethoscope on the chest and listen for a minute, or you can do an EKG, which is actually measuring the electrical tracings of the heart. If that is, in fact, flat, then the pope has passed away.

O'BRIEN: All right, there was another report we saw come across the wires, which came from a Mexican prelat (ph), who said, the pope was in agony. That was the term. And I something may have gotten lost in translation there. Why don't you explain that as well.

GUPTA: Yes, there's something that's well known, especially in terminal, patients called agonal respirations. And this is end of life type of respirations. It does not imply that the patient, or person, is in any pain, or there's anything going on besides the fact that there is some labored breathing, which is very consistent with someone who is at the end of their life, in this case, because of the sepsis, which is the infection throughout the body. The body often responds by quick, labored breathing.

O'BRIEN: And let's explain that infection, how that infection has spread and what its implications are to the human body.

GUPTA: We first heard that in fact yesterday, almost 20 hours ago now, that he had a drop in his blood pressure, which is some of the first signs of a body-wide infection. Then it was isolated to the urinary tract. What has probably happened here, Miles, and this isn't uncommon in this age group -- is the bacteria in the bladder, or the kidneys, actually spread into the bloodstream, and started to make its way around the body. That is what septic shock is. What it can cause is a collapse of the cardiac, the heart, as well as all the other blood vessels.

O'BRIEN: So when you say septic shock, is that almost always the end? Is that a terminal condition, or can, you know, with concerted treatment, can somebody be brought back from septic shock? GUPTA: Someone could be brought back from septic shock, although given his age and his preexisting medical conditions -- we did our homework on this -- even in the intensive care unit with the best sort of care -- IV, antibiotics, medications to raise your blood pressure and help your heart. Even with all that, about a 20 percent survival from the full-blown episode of septic shock.

O'BRIEN: And of course, the pope has chosen to remain in his apartment, where of course there is quite an array of medical capability. But we're not talking about necessarily an intensive care unit.

GUPTA: That's right. I don't know what the capabilities are in the Vatican. They seem like they're quite good, but I don't think they're an intensive-care unit.

O'BRIEN: Let's just back up for just a moment and put this all under the big picture of his sort of preexisting health condition, Parkinson's and all the other things and kind of walk us through the progression that we've seen -- we've witnessed here.

GUPTA: Yes, first of all, his general health, obviously, very poor. The Parkinson's, significant arthritis, which is relevant because he was immobile as a result of this arthritis. He'd been shot. Everyone knows that as well. He seemed to have a general decline of health conditions after that assassination attempt.

With the Parkinson's, we hear, you know, some difficulty with the breathing. He was in the hospital for 10 days in February, and then back in the hospital less than two weeks after that for this breathing tube. My impression is he never fully recovered from that initial hospitalization two months ago to the day now.

O'BRIEN: And it's interesting, when you get to be an octogenarian, there is a cascade effect, isn't there, the dominoes just kind of start to fall, don't they?

GUPTA: Absolutely. The flu-like symptoms 10 days, a breathing tube, followed by a feeding tube, followed by a fever, low blood pressure, septic shock, and now we're hearing about his heart as well.

O'BRIEN: You know, it's interesting as we look, by the way, at the light on at the papal apartment there in Vatican City, it's interesting you mention the shooting. That's not often plugged into the picture here, because he was so vital. He seemed to have a full recovery, and this is we're talking 1981. And most of our history with the pope were very vital days subsequent to that shooting. And yet there are lingering effects that perhaps we haven't seen all these years.

GUPTA: And I don't profess to know his entire medical history. But I have talked to a lot of doctors about him. And doctors have commented, since that time, he seemed to have a very slow, but progressive, gradual decline in health. In now way is nobody saying that Parkinson's Disease is a result of the assassination attempt, but he did seem to have a gradual decline after that. O'BRIEN: Interesting, Parkinson's also, there's kind of a vicious cycle here between the infection and Parkinson's. The Parkinson's makes the infection likely, the infection makes the Parkinson's worse and so forth. Explain that.

GUPTA: Absolutely. It is a vicious cycle. Just because of the immobility, Parkinson's Disease doesn't actually suppress your immune system in any way, but because of your immobility, you're more likely to develop infections.

When I heard about fever yesterday, I thought it was going to be a pneumonia. That's actually a more common fever source than the urinary-tract infection. But then once the infection has set in, it actually makes the Parkinson's symptoms worse as well. So it's sort of a vicious cycle. Someone who has worsening Parkinson's symptoms can seem even more lethargic, even more immobile. All of that might be moot at this point, given how significant his sepsis is.

O'BRIEN: Is this a not unusual demise then, for someone with Parkinson's to have this kind of effect?

GUPTA: Yes, this is common, to have some sort of infection that gradually seeps in the body.

O'BRIEN: Sanjay Gupta, thank you very much, learned a lot. Appreciate it.

Jim Bittermann is in Rome.

And, Jim, tremendous experience covering the Vatican through these times. Jim, I'm just curious, in this day in age, how the release of information compares to what you experienced nearly 30 years ago now?

JIM BITTERMANN, CNN CORRESPONDENT: Well, one of the things, Miles is the incredible media exposure this time around. I mean, back then, we were still recording on film, and we had to put up with satellites that occasionally passed overhead that you could bounce the signal up for a few minutes each hour. So I mean, there was a lot less communication capability than there is today.

I think one of the things that will change things in the way we cover the next few days and weeks here, as this papal transition takes place, if in fact it does, is that the communication will be much different than it was back then.

Back then, of course, it was just Rye (ph) Television. That was the only state channel that was putting out news here. We're getting a lot of news this evening from a lot of different media outlets, and media sources in Rome and in Italy.

So it's changed the picture completely. The other thing that will happen, too, is that we'll see coming to Rome just an incredible number of people, not only from the media. We're going to see, I think, coming a number of different strands of the Catholic Church, who want to be represented here as this very important job takes place, this very important job of picking a successor. You'll see people coming from various Christian movements, various Catholic movements around the world who want to, in a sense, lobby the cardinals in a way that didn't take place back in 1978 -- Miles.

O'BRIEN: Well, that would be an interesting thought, to think about lobbying a conclave, which of course is not the thing that is subject to lobbying.

Interesting thing here, I thought. Well, go ahead if you want to amplify on that, Jim.

BITTERMANN: No, I was just going to say that the sense of the conclave is complete lockdown. I mean, there's nobody allowed to talk to the cardinals inside the convent. What I'm saying is in that period of time between the pope's death and the beginning of the conclave, there's a 15-day period in there, in which mourning for the pope takes place and various congregation takes place. These days it will be completely different. For one thing, these cardinals all carry cell phones nowadays. Back then, there no cell phones around. You would have to go across town and meet somebody for coffee or whatever. These day you can put together a cell phone network, you can send out SMS messages -- you can do all sorts of things if you wanted to communicate directly to the cardinals and you knew their cell phone numbers.

O'BRIEN: Well, it's a long way from St. Peter's when you start talking about SMS messages for the next pontiff, potentially. Let me ask you this, Jim. It seemed as if the Vatican press office, just reading the tea leaves here, was very deliberate in announcing today that the pope had appointed 17 new bishops and archbishops, accepted the resignation of six other archbishops. That little piece of news is symbolic in many senses, isn't it?

BITTERMANN: It is in a lot of ways. For one thing, those bishops' names and the resignations would all have to be approved by the pope. That's the church rules. You can't become a bishop unless the pope chooses you as a bishop. At some point along the line, the pope had to approve those names. Now, whether that took place today or not, we just don't know. It was certainly announced today. Whether the pope made his decisions today, we just don't know.

But it could be taken two ways. Either the Vatican wanted to show that the work of the church was still going, or, perhaps, the Vatican is wanting to get its house in order before a papal passing. It would be completely impossible for the Vatican to announce the names of bishops after they had announced that the pope had died.

O'BRIEN: And while we're talking about that -- we talked about the media's presence there. Once again, live pictures now. That's the papal apartment, with the lights still blaring. We've talked about the amount of media attention. Let's talk about how much more information, relatively speaking, the Vatican is providing the media at this time. This is not something that -- it's not a forthcoming outfit, is it?

BITTERMANN: Well, this is something that changed literally overnight. I don't know if you remember just a few weeks ago, when we were standing outside of Gemelli Hospital, hoping we'd get some kind of information about what the pope's condition was. In fact, that all changed in the last 24 hours.

The Vatican came forward with incredible amounts of information about the exact papal condition, some of it shepherded by a doctor himself. That's the doctor Joaquin Navarro-Valls. The papal spokesman is also a medical doctor, and sometimes his medical bulletins reflected that because they were pretty technical.

I think, you know, maybe, though, it was a sense that there was no point in further spinning it in a positive way and further making it look like things were going on as normal or trying to make it look like things were going on as normal. Just a need to sort of inform the world's Catholics. I mean, this is the age of the 24-hour news network. It's a different age than it was back in 1978, the last time there was a papal transition.

O'BRIEN: Yes. And you know, it's worth pointing out the church can be slow to change. But they are also well plugged into the realities of leadership here and exactly how these things unfold and how, in order to lead the faithful. Jim Bittermann, thank you very much. Stay close.

CNN's Alessio Vinci is back with us. Alessio, what can you tell us?

ALESSIO VINCI, CNN ROME BUREAU CHIEF: Hello, Miles. Well, if, indeed, the pope were dead, the person who is in charge of announcing his death to Rome is the vicar of the pope for Rome. As you know, the pope is the bishop of Rome. His vicar, Cardinal Camillo Ruini, would be the person in charge of announcing to the Roman people that the pope has died.

Cardinal Camillo Ruini has just finished celebrating a mass here in San Giovanni Leterrano (ph). Thousands of people have just left this building, most of them unaware of this latest report from an Italian news agency that the pope has died. I think that nobody really here is ready to confirm this piece of information officially. We have not heard from Cardinal Camillo Ruini. It would not be unusual for the cardinal, if this information would have been correct, to actually say something, perhaps at the end of the mass.

I can also tell you that right next to me there are several positions of Italian state television (INAUDIBLE). That is also a means through which Cardinal Ruini could, in theory, announce to the people of Rome and indeed, to the people of Italy that the pope has died. So all this is not happening at this time.

Unfortunately, I don't know exactly whether Cardinal Ruini is still inside the cathedral or whether he has left already, but I can tell you that at the end of this mass, there was no mention of the fact that the pope had died, basically.

O'BRIEN: All right, Alessio.

VINCI: Back to you -- Miles.

O'BRIEN: Just to follow up on that, we, of course -- we've been telling our viewers about reports on Reuters quoting some Italian news agencies that the electrocardiogram may, in fact, have gone flat. We do not have any independent verification of that.

And Alessio, what you're alluding to you here is, over the years, we have been told of these things in a very formal, symbolic way, in many ways. Doors opened or shut, shutters shut. That kind of thing. In this case, in day and age, it may not happen that way in this day and age, will it?

VINCI: That is correct. I mean, even in the old days, even the way the pope's death was being certified, you had the Cardinal Camerlengo (ph) tapping with a silver hammer on his forehead, calling his baptismal name. We're not necessarily sure that this is happening again this time around. Actually, that procedure was probably eliminated with John the 23rd, I believe. So, obviously, modern medicine has different ways to discern whether a person is dead or not.

Certainly, all these indications of the lights on, lights off, we can't really read anything into it. Last night, for example, when the Vatican announced the pope actually had a high fever and had infection to his urinary tract, as well as being on antibiotics, the lights of his Apostolic Palace was switched off. And, you know, we couldn't even really understand why.

So these are all, if you want, small elements that perhaps are just at this time in the evening and, there's obviously a lot of confusion here in Rome at this time. A lot of speculation about what is really happening, perhaps. You know, it could also mean that a person may have forgotten, you know, to turn the switch on or to pull a curtain or whatever.

Regarding the Italian media report about the electrocardiogram, Miles, I need to be very specific about this, because the Italian media -- the Italian agency was reporting this, in Italian, of course, is not talking about an electrocardiogram. They are talking about what is known as an EEG, which is a machine that monitors brain activity.

So if, indeed, this Italian agency is right -- and we have not been able to confirm this, so we're not telling you this is the case. If, indeed, this Italian agency is correct, what they're talking about is cerebral activity being basically zero, not his heart.

So this is a very, you know, distinction that I would like to make. Because there have some problems with the translation here. But it is -- the Italian news agency here is talking about his cerebral activity, not his heart.

O'BRIEN: All right, Alessio. This is where it becomes very convenient to have a doctor on call and at the ready at all times. Dr. Gupta, walk us through the EEG, the significance of -- essentially, brain wave activity ceasing. GUPTA: That's right. And Alessio's exactly right on this. The EKG is actually monitoring your heart activity, whereas the EEG is monitoring the brain activity. Very different, obviously, not just in terms of the organs that they're measuring, in terms of the activity, but also in terms of the significance.

EEG and brain death is something that we've defined more recently, within the last 40 years or so, actually being able to say someone is brain dead. Their brain will not recover. This is -- this became a more accurate description for people who are considering organ donation, for example. EKG, measuring the heart activity, is what is used as the criteria for actual death, versus brain death.

O'BRIEN: So that remains sort of the official threshold between life and death, is the functioning of the heart?

GUPTA: The functioning of the heart, either by EKG or, as we were talking about, someone actually putting a stethoscope and listening for any heart activity for a full minute. If there is no heart activity, that is also a criteria to pronounce someone dead.

O'BRIEN: All right, and you know, I can't help but hearken back to what we've been talking about all this past week with Terri Schiavo, where the thresholds of life and death lie. Medicine gives us so much. Modern medicine gives us so many capabilities and really makes it very difficult to define that moment, doesn't it?

GUPTA: It does. And there's several different conditions, as well. For example, the person who is being examined cannot have any medications that might make their heart slow. They cannot be -- have a cold temperature, for example, that might make their heart slow. So if those criteria are met and someone doesn't have any electrical heart activity, then it's fair and consistent around the world to pronounce them dead. But you know, with the EEG alone, this is just a brain death. The heart could still be beating, the organs could still be functioning, even with the brain death EEG.

O'BRIEN: And of course, we really don't know what the pope's wishes were in these final moments. You know, we've talked about living wills a lot, as well. And it's difficult for us to understand, except on the face of it, he did make that decision to stay home. And that is telling, isn't it?

GUPTA: It is telling. And let me make it a little bit more confusing, which I don't mean to do, but if someone, in fact, has a brain death EEG, but their heart is still beating, then almost by definition, they are requiring a mechanical breathing machine, OK? You see what I'm getting at here.

O'BRIEN: Yes, I do.

GUPTA: So if someone is brain dead but still has a functioning heart, the only way that could still be happening is with a breathing machine. And I don't know that the pope's on a breathing machine, but if those two things are accurate, then he would almost have to be. O'BRIEN: Interesting to ponder at this moment. Yet another thing we don't know as we consider what is obviously the final moments of John Paul II. Sanjay Gupta, thanks very much -- Betty.

NGUYEN: And speaking of what we don't know, let's be very clear right now that Italian media gave contradictory reports, first saying that the pope had passed away, now saying that that is not the case. At first they said his heart and his brain activity had stopped. Now, Italian media is reporting that is not true.

We want to get some clarification now, and for that, let's go to CNN Vatican Analyst Delia Gallagher, who is there in Rome. Delia, what are you learning at this moment?

GALLAGHER: Well, Betty, we've got exactly what you've just reported, which is that Italian wire report. In a sense we are still very calm here on the ground because, if you've worked at the Vatican for a while, you understand, in particular, with this story, there is huge anxiousness and a sort of freneticism to get the latest news.

Now, that's considered part and parcel of journalists at work these days. But at the Vatican, I think that is increased in some way because the Vatican generally doesn't respond to news reports. This is, obviously, a very different case, but in the past, journalists have been a bit spoiled, perhaps, in their ability to throw out some stories without getting an immediate response or denial from the Vatican.

So there is a very particular working situation here for journalists at the Vatican who, obviously, have to be very careful with the delicate story, but at the same time, would like to try and arrive first, in a sense. But they need to get it right.

Betty.

NGUYEN: And that is key, to get it right. And again, we want to be very clear that CNN has not made confirmation that Pope John Paul II has passed away. In fact, Italian media reported that just a little bit earlier, but has now said that that is not the -- is not true. And the Vatican was also quoted as saying that both the pope's brain and heart were still functioning. Talk to me a little bit, Delia, about who might be with the pope at this hour.

GALLAGHER: Well for sure there is his private secretary, a man who is behind the scenes and doesn't get any publicity, but those of us at the Vatican know him very well. He's Don Stanislaw Dziwisz. He has been the private secretary of the pope for 40 years and his closest adviser and friend. He is the man that you go through if you would like to see the pope. So he is a very at once powerful, but he is a very kind and compassionate man, and has certainly been at this pope's side throughout his pontificate and even before in Poland.

There are obviously, a few aides that help Don Stanislaw with the pope, as well as several Polish nuns who run the household.

And clearly at this time, there will be medical doctors. We know earlier today that four top Vatican cardinals went to visit the pope, one of whom an American, Cardinal Shulka (ph). He is from Detroit, and he is the governor of the Vatican city-state, an important cardinal here at the Vatican.

So there has been some activity. At this moment we do not know who is in the room with him, but surely, those closest aides are with him.

NGUYEN: CNN's Delia Gallagher there in Rome for us. Delia, stand by. We'll be coming back to you shortly. Miles.

O'BRIEN: Catholics all around the world have their attention focus on this very this event, more than a billion of them, 60 million of them here in the United States. Among the places that is are focuses of attention, of course the cathedrals and churches all around our nation. CNN's Joe Johns joins us from Washington at just such a place, where many of the faithful are coming to say a few prayers for Pope John Paul II at this moment -- Joe.

JOE JOHNS, CNN CORRESPONDENT: Miles, this is the Cathedral of St. Matthew in downtown Washington. Archbishop Theodore McCarrick, this is his home church. We've be following him throughout the morning, as you know. He said a mass earlier today. This sort of gives us a window on how at least some of the cardinals are getting information. He is very frank about the fact that he is watching television to try to get word on the pope's condition. He does also expect to get a news from Rome. But quite frankly, he's watching TV, he's watching the media.

We're told just a little while ago, he did leave the cathedral here to go back to his office, where he said he'll wait for word there. But as much as everyone else, he's watching electronic media to try to find out what's going on -- Miles.

O'BRIEN: Yeah, Cardinal McCarrick had some very interesting things to say just a little while ago, right before we came on the air. And I want to throw this one thing at you. He said that John Paul II was, in a way, American. He liked people. He was humble. Pardon me for that past tense there, but I'm just quoting the cardinal there. Therefore, we became close to him. It was an interesting point, don't you think?

JOHNS: Yeah, interesting point. Also, he said that, in his view, one of the things that made him so popular in the United States was his connection with young people around the world. And he felt that that is at least part of the reason why John Paul was so well known and well liked throughout the United States. Clearly, though, he also said during the mass just a little while ago that there were times when John Paul would surprise the people who worked with him, meaning the other cardinals, by taking on certain issues that they weren't all clear which direction he was going to go on. So just a testament, I think, to an extraordinary man, the pope, whether, of course, he lives or dies right now.

O'BRIEN: Yeah. You mention a really interesting point as we look at live pictures from the Vatican as the faithful gather together there. In so many ways, John Paul II was just the right man at the right time to serve in that papacy -- the first real full-fledged television-age pope. Really had a way of connecting with people at that level, didn't he?

JOHNS: Well, certainly, it's true. And another point that was made today by Archbishop McCarrick is that even now, when the pope is apparently at the end of his life, he finds himself setting an example -- an example, they say, of how to die, and suffering. A lot of people I've spoken to here again and again have said, in suffering, there's a certain amount of dignity. And they say that is what he's showing at this time, Miles.

O'BRIEN: Joe Johns in Washington with the faithful there, gathering as they are all over the world right now, as you see live pictures in St. Peter's Square. A lot of somber faces. A lot of prayers being said right this moment for John Paul II.

Thank you, Joe -- Betty.

NGUYEN: We want to go now to CNN's Jim Bittermann, who is in Rome. And Jim, we are looking at these live pictures of so many people gathered in St. Peter's Square. Obviously, the mood is a very somber one.

BITTERMANN: Absolutely, Betty. And in fact, one of the things that we expect to happen here just in the next few minutes is Cardinal Camillo Ruini, the vicar of Rome, who was just delivering a mass and celebrating mass over at St. John Laderan Church, is going to come here to St. Peter's Square and lead the crowds and lead the faithful in the rosary, a rosary dedicated to Pope John Paul II.

As these people gather, one of the things that's been kind of unfocused for a lot of the faithful is exactly where to go and what to do. Where should you go? Will we get anything that would resemble activity out of the Vatican? And one of the reasons why Cardinal Ruini has chosen to conduct these rosaries tonight is to -- and lead the crowd through these rosaries I think is that it will help the faithful, bring them together with the pope at this hour.

NGUYEN: Jim, we reported earlier that Italian media was having a lot of different reports out there about the pope's condition. Well, we have just learned that the Associated Press is saying that the Vatican has denied reports that Pope John Paul II has died. Now, you had mentioned Cardinal Ruini would be coming out shortly to lead in a rosary. Do you expect any kind of statement from him as to the pope's condition?

JOHNS: No, we don't. And I don't think that would sort of be the way things would take place. It's conceivable, of course. This has been a very surprising day, in many ways. So I think anything could happen. But -- and it is Cardinal Ruini who is charged with the responsibility of announcing the pope's death. Having said that, we understood from the Vatican press office that, in fact, he's going to just lead the crowds in rosaries.

And I should say there have been rumors flying around the Vatican all day long, all night last night, as a matter of fact, about the pope's death, about his condition -- exact condition, and all that sort of things. A lot of them have been disproved over the hours that have followed. So I don't think we want to put too much stock in the kind of rumors that are coming around.

There's an awful lot being said. We know that the pope is dying. The papal spokesman has made that clear. In fact, Cardinal Ruini himself this evening in the mass said, "The pope already sees and touches the Lord. He's already united with our Soul Savior." So not a very optimistic accounting there from Cardinal Ruini himself. But I think that's the kind of thing we have to follow for guidance rather than the Italian press story.

NGUYEN: And it's words like that, obviously, that in times like this really brings, I guess, some solace to people as they're watching the pope and his ailing health.

BITTERMANN: Yes, that's right. I think -- I think one of the things that was clear, too, in what has been said is that the Vatican believes that by showing the pope suffering they are setting an example and symbolically showing Christians not only have to live but, as Cardinal McCarrick said a little while ago, showing them not only how to live, but also how to die -- Betty.

NGUYEN: Jim Bittermann, we're going to ask you to stand by. We'll be checking in shortly. Thank you for that -- Miles.

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