VATICAN CITY -- Five years ago Friday, just three days before a grand conclave of his fellow cardinals gathering in the Sistine Chapel elected him Pope Benedict XVI, Joseph Ratzinger marked his 78th birthday as he always did, with a strudel prepared for him by his personal staff.
The dessert is a favorite of the German-born pontiff, who acknowledges a weakness for sweets. But on his birthday this year, leading American cardinals and U.S. churchmen from the Papal Foundation, a major Vatican fundraising organization, presented Benedict with a custard cake topped with strawberries and kiwi fruit. "Happy Birthday, Holy Father" was written on top, and best wishes and prayers were exchanged in the ornate Sala Clementina in the Apostolic Palace.
Yet behind the good cheer and the warm show of support, concern about Benedict's health is increasingly a topic of discussion here in the Vatican and around the church, given the reality of his advancing age but also growing worries about the toll that widening revelations of sexual abuse by clergy are taking on Benedict's constitution.
The pope has never been a terribly vigorous fellow, nor as vigorous as his athletic, globe-trotting predecessor, John Paul II. In recent weeks, Vatican observers and some who have seen the pope up close have spoken in worried tones about his health, saying he has appeared very fatigued at times. That is what Father David O'Connell, president of Catholic University of America in Washington, found when he met with the pope at the end of March.
"He looked like he's aged significantly since the last time I saw him, when he visited Catholic University in 2008," O'Connell told "The NewsHour" on PBS. "And some of his collaborators said to me that they thought the pope was feeling the burden of this very deeply and very personally."
Another American priest who frequently visits the Vatican described the pope as "harried," which is an unsettling adjective, given that it is so rarely applied to Benedict, an academic by profession and disposition who always acts very deliberately and is rarely knocked off his game by daily events and pressures.
More recent conversations with others in and around the Roman Curia have been a bit more hopeful about how well the pope is faring at 83, especially since he returned from a restorative post-Easter break at Castel Gandolfo, the papal villa in the hills outside Rome.
Still, all are guarded about any prognosis, which is only natural. At 78, Benedict was the oldest man elected to the papacy since 1730, when another 78-year-old, Clement XII, was chosen after a long conclave. (The precedent is perhaps not a hopeful sign. Clement lasted for a decade, but he was blind, often bedridden with gout, and senile for much of his papacy. Still, Clement did build the Trevi Fountain, ensuring the future success of Rome's tourist industry.)
Benedict has a heart condition, details of which are not known. Back in 1991 he was hospitalized for what was apparently a minor stroke or something similar, and he was said to be taking medication for a circulatory ailment. In 1992 he suffered further hemorrhaging after he slipped and cut his head on a radiator while on vacation. There is no indication that those episodes have had lasting effects. "Thank God, there are hardly any traces of it now," then-Cardinal Ratzinger told Time magazine after the 1992 incident.
Indeed, Benedict has seemed in good form since he was elected pope, and he has something of an ageless, grandfatherly look, with a thick shock of white hair that he has sported for decades. When a deranged woman leaped a barrier in St. Peter's Basilica at midnight Mass on Christmas and tackled the pope, he got right back up and continued with the liturgy. (The Mass, in fact, had been moved up two hours, to 10 p.m., to help conserve the pope's energies.)
But Vatican officials have been careful to curtail his daily schedule and foreign trips, and also to make sure he gets plenty of breaks after a busy stretch, like Easter or Christmas. "They limit him, and he wants them to," said an American priest currently in Rome. "He's very careful. He knows he has physical limitations, and he's been very prudent, keeping within his limits, especially in the last couple of years."
Benedict signaled from the start that he suspected his would not be a long papacy, telling the cardinals right after his election that he hopes "in this short reign to be a man of peace." Benedict's brother, Father Georg Ratzinger, (who is three years older and has a pacemaker but otherwise appears to be in good health), also was none too sanguine about the actuarial tables. "I'm not very happy," Georg said the day after Joseph became pope. "He's OK, and his health is good. I just wish for him that his health holds out and that his office isn't a worry and a nuisance to him."
Benedict's concerned sibling has reason to worry now, given the level of criticism that revelations of clergy sexual abuse has aimed at the pontiff.
Still, discussion of the pope's health remains a touchy subject in the Vatican for a number of reasons.
One is that treating a pope's physical condition with the candor of, say, the president of the United States, whose annual physicals are released by the White House, would in the eyes of some diminish the powerful mystique that has long enveloped the pope.
But a veil of secrecy is also designed to protect the papacy, since word of a pope's declining health tends to set off fevered media speculation and -- more ominously -- the kind of ecclesiastical politicking that the Vatican does not want to encourage. Hence the Roman adage that "a pope is never sick until he's dead."
That line played well enough in past centuries, when medical practices were as likely to kill an old man as heal him, and when popes were not media figures and statesmen constantly in the limelight. In those times, pontiffs could dodder on in senility for months, even years, without anyone being the wiser, and without the pope saying or doing anything about doctrine or dogma that would cause the faithful to scratch their heads.
"In the good old days his staff might lock him in his rooms and run the church until he died," Father Thomas Reese, a political scientist of the church, wrote in his book "Inside the Vatican." "In the bad old days someone would poison him. Either strategy would be difficult to carry out in the full blaze of today's media attention."
The miracles of modern medicine have also changed the dynamic. It is no surprise that the longest-serving popes are among the most recent ones. Among the 264 popes over nearly 2,000 years since St. Peter, John Paul II's reign of more than 26 years is surpassed only by that of Pius IX (1846-1878), who reigned for nearly 32 years. Next in the longevity line is the pope who followed Pius IX -- Leo XIII (1878-1903), who lasted more than 25 years.
The real fear now is that a pope's body will outlive his mind, as there is no real mechanism for determining if and when an ill pope could step down (as we detailed in this story
Pope John Paul II helped ease (somewhat) the secrecy about a pope's physical health when he insisted on allowing photographs to be taken of him in his hospital bed after the 1981 assassination attempt; that was considered a major break from papal protocol. Then in the last years of his pontificate, John Paul did not shy away from public appearances even as a degenerative neurological disease (which was only grudgingly acknowledged by the Vatican and never explicitly diagnosed as Parkinson's) assailed his body and inexorably turned him into a kind of living martyr.
After John Paul's death, the papal apartment was fitted out as a virtual hospice; an ad hoc medical clinic that had been used to treat John Paul between his hospital visits was modernized and expanded (it even includes dental equipment). That could keep medical treatment of the pope even more closely guarded.
In any case, the length of Benedict's papacy may not be the best indicator of its effectiveness or consequence.
Pope John XXIII, for example, was elected in 1958 at the age of 77 to be a "bridge pope," a placeholder of sorts until the College of Cardinals could better figure out where it wanted the church to go, and who should lead it there. But "Good Pope John," a stolid career diplomat for the Vatican, surprised everyone by announcing a year later that he was convening the Second Vatican Council, a major event in church history. Pope John died in 1963, before the council ended, but its reforms in church practices and teachings are still roiling Catholicism.
Moreover, it's always perilous to speculate about a pope's health. Vincenzo Pecci was a frail, 68-year-old cardinal when in 1878 his fellow electors chose him to be Leo XIII -- with the clear intent to have him serve as a transitional pope. There is no out-smarting Providence, however, and Leo lived to be 93. Many suspected that the secret of Leo's vigor was the sparkling red wine he loved, called Vin Mariani, which happened to be laced with cocaine. The pope endorsed the wine in ads, and it was also favored by Queen Victoria and President McKinley.
For his part, the current pope is known to be fond of simple orange soda. Maybe it will have the same effect.