An American pope brings American-style governance to the Vatican, even in a health crisis

VATICAN CITY (AP) — There’s a telling anecdote from St. John Paul II's pontificate that illustrates how Pope Leo XIV and his American style of governing have changed the Vatican and the way it handles papal health crises.

The Polish pope, 84 at the time, was back at Gemelli hospital battling an acute respiratory infection, breathing problems and the worsening effects on his larynx of Parkinson’s disease, which had made speaking nearly impossible and breathing difficult.

Doctors performed a tracheotomy under anesthesia, an incision in John Paul’s windpipe, to help him breathe. And yet the next morning, his spokesman gave reporters a remarkably rosy, seemingly implausible update: John Paul had eaten his regular breakfast of coffee with milk, 10 biscuits and a yoghurt.

“Something that would suffocate anyone,” church historian Alberto Melloni recalled Friday. “But it was normal then that they told lies about the pope. Those were the rules of the game.”

Two papacies and twenty years later, Pope Leo XIV has changed the rules of the game.

Not only did history’s first American pope announce himself that he had a lung nodule that required surgery – live on television during his Sunday noon blessing from the Apostolic Palace — but Leo's doctors have been providing the medical updates for his recovery, not the Vatican.

Every day since Leo’s surgery Tuesday, Leo’s personal physician Dr. Luigi Carbone and the head of thoracic surgery at Gemelli, Dr. Stefano Margaritora, have signed the medical bulletins updating the world on Leo’s recovery. The Vatican spokesman has provided information primarily involving non-medical details: The Mass Leo celebrated, the Vatican officials who visited.

The written medical updates are spare, but provide authoritative information with a degree of accountability and transparency that has long been anathema to the Vatican.

Leo’s handling of his cancer is in many ways textbook American-style corporate good governance, applied to the Catholic Church, said Julie Rubio, a professor of Christian social ethics at the Jesuit school of theology at Santa Clara University.

“Even though it doesn’t seem all that revolutionary, ‘best practices’ of relying on experts, transparency, evaluation -- all those kinds of things are practices that are good for an institution,” she said.

She said Leo, the American math major pope, had already brought such best practices into his governing style at the Vatican, most visibly in the official rollout in May of his encyclical on artificial intelligence.

Rather than have a handful of prelates talk about the encyclical at a Vatican press conference, Leo himself presided over the presentation . To provide a spectrum of voices, perspective and experience, Leo had on the stage with him three cardinals, two lay female theologians – from Britain and Congo -- and the co-founder of AI developer Anthropic.

Rubio said the inclusive presentation was in keeping with the effort, begun by Pope Francis, to make the church less clerical and more reflective of the real world. It's a church that relies on lay expertise in the way that Leo relied on medical advice to have the nodule removed, she said.

“Those kinds of practices actually can be pretty transformative to a place,” she said. “Though obviously the transformation is a process.”

The process began to some degree under the Francis pontificate, when the Argentine pope took the reins of the Vatican communications apparatus and gave dozens of sit-down interviews over the course of 12 years, often without informing his media handlers. That level of control precluded a Vatican media operation from spinning tall tales as occurred during John Paul's reign.

But when it came to his own health and governing style, Francis was opaque, stubborn and often shunned expert advice. His go-it-alone attitude, in everything from Vatican diplomacy to communications, extended to his view of doctors. He repeatedly refused medical advice, even as his already fragile respiratory health and mobility deteriorated.

Francis had strained ligaments in his right knee that made walking difficult. But he refused to operate on it, saying he didn’t like the effects of anesthesia. Eventually he was unable to walk and had to use a wheelchair. He similarly refused to go to the hospital as his pneumonia worsened toward the end of his life, even as he swelled with the effects of cortisone and other treatments.

Melloni recalled that Francis was very much a Jesuit, a militant-style religious order and its pope a “Rambo-style” fighter who governed alone. He was, Melloni said, “a man who takes care of himself, a man who if injured fights back, a man who always had to give this proof of military-style valor.”

Leo, on the other hand, is the perfect civilian patient: He listens to expert medical advice and follows it, like most people who get sick, Melloni said. Leo moved quickly to remove the nodule, considering other cases of cancer in his family, with his brother currently being treated for blood cancer, he said.

"He knows that this disease —as is obviously the case with all diseases of that sort — is unpredictable,” he said.

Leo is making his mark on governing, even from the hospital , and showing who is in charge in other ways, too.

Late Friday, the Vatican announced he had spoken by telephone with Russian President Vladimir Putin and “expressed his deep concern about the grave humanitarian situation in the city of Oleshky, in the Kherson region, and called for a ceasefire to allow the delivery of food and medical assistance, and the voluntary and safe evacuation of the civilian population.”

The statement was significant, showing Leo was well enough to conduct official diplomatic business from the hospital, was keeping up with world events and was continuing to promote his message of peace as he recovers from surgery. The Kremlin readout of the call suggested progress had actually been made on the humanitarian front.

But the demonstration of Leo's leadership was significant also because it came as intrigue was consuming the Vatican over the fate of the secretary of state, Cardinal Pietro Parolin. The seasoned diplomat had said Leo's pontificate may have to be “adjusted” given his cancer diagnosis, a bold claim given all indications were that Leo was recovering well.

Parolin, who had been Francis' top deputy but remains in the job, was considered a leading contender in the conclave that elected Leo and was recently passed over as dean of the College of Cardinals.

Perhaps tellingly, he was not among the Vatican officials who visited Leo Friday.

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