Pope Francis has told confidants that he may not survive a case of pneumonia that saw him hospitalised last week after doctors told him 'in no uncertain terms he was at risk of dying' if he stayed at the Vatican.
The pontiff, 88, was rushed to Rome's Gemelli hospital on Friday with significant chest pain, having resisted calls to leave the Vatican for days.
Doctors diagnosed him with a 'complex' respiratory infection and barred him from taking part in several engagements, with the Vatican cancelling or rescheduling his papal audiences this week.
The Vatican on Tuesday confirmed the pneumonia and said Francis' respiratory infection also involves asthmatic bronchitis, which requires the use of cortisone antibiotic treatment.
'Laboratory tests, chest X-ray, and the Holy Father's clinical condition continue to present a complex picture,' the Vatican said.
The infection is of particular concern because the Pope had part of his lung removed many years ago.
Now, two people close to the pontiff have claimed Francis told them that he 'might not make it this time', according to a report by Politico.
Perhaps cognizant of his limited time, the Pope has in recent weeks moved to 'tie up loose ends' and ensure the continuation of his legacy at a politically sensitive time for the Catholic Church.
Appointed pope in 2013, Francis has led a relatively progressive but controversial papacy that has seen women accede to key roles, the recognition of LGBT+ rights and the Vatican begin to address Catholic Church child abuse scandals.
One person close to the Pope told Politico that Francis' move to extend the Italian cardinal Giovanni Battista Re as dean of the College of Cardinals - controversially sidestepping a vote on the position - was to ensure the next Pope is likely to be one favoured by Francis.
Re is too old to participate in the conclave - the gathering of Vatican high-ups who choose the pope - but insiders said he would be able to influence the lobbying and political jockeying that occurs ahead of the meeting.
'The run-up to the conclave is more important as that's where lobbying goes on,' the source said, adding that Francis is hoping the 'friendly face' of Cardinal Re will ensure his successor continues his legacy.
Francis last weekend appointed a nun, Sister Raffaella Petrini, as the first-ever female governor of Vatican City ahead of schedule.
And insiders warn the next conclave could be highly politicised, with Francis having issued a stinging condemnation of the Trump administration's migration policy.
Francis addressed the US migrant crackdown in a letter penned earlier this month, criticised the expulsions as harming the most vulnerable, shortly after Vice President JD Vance attempted to justify the deportation programme on theological grounds.
The Argentine pontiff has repeatedly defended the rights of migrants during his 10 years leading the Catholic Church, urging world leaders to be more welcoming to those fleeing poverty or violence.
Citing the biblical stories of migration, the people of Israel, the Book of Exodus and Jesus Christ's own experience, Francis affirmed the right of people to seek shelter and safety in other lands and said he was concerned with what is going on in the United States.
'I have followed closely the major crisis that is taking place in the United States with the initiation of a program of mass deportations,' Francis wrote.
'The rightly formed conscience cannot fail to make a critical judgment and express its disagreement with any measure that tacitly or explicitly identifies the illegal status of some migrants with criminality.'
It is one thing to develop a policy to regulate migration legally, it is another to expel people purely on the basis of their illegal status, he said.
'That said, the act of deporting people who in many cases have left their own land for reasons of extreme poverty, insecurity, exploitation, persecution or serious deterioration of the environment, damages the dignity of many men and women, and of entire families, and places them in a state of particular vulnerability and defencelessness,' he concluded.
Sources told Politico that Francis' condemnation of US government policy could mean the papal succession battle could become highly politicised.
'They've already influenced European politics, they'd have no problem influencing the conclave... They might be looking for someone less confrontational,' one observer said.
As insiders and observers speculate over the impending succession battle, doctors in Rome continue to treat Francis.
On Monday, medical personnel determined that he was suffering from a polymicrobial respiratory tract infection, meaning a mix of viruses, bacteria and possibly other organisms had colonised in his respiratory tract and led to double pneumonia.
Treatment varies by severity but can include providing oxygen through a nasal tube or mask, intravenous fluids - and treatment of the underlying cause of the infection.
To date Francis is not known to be using supplemental oxygen, and he has eaten breakfast every day, read the newspapers and done some work from his hospital room.
The Vatican hasn't provided any information about how Francis is responding to any of the drugs he has been given other than to say he isn't running a fever.
Dr. Carmelo D'Asero, an infectious disease and geriatric disease expert in Rome, said Francis' lack of a fever was not necessarily a positive thing, given the seriousness of his infection.
'A high fever is a sign of an immune response to a pathogen,' he said. 'Having a low fever and having a serious bronchial infection .. is a sign of a decreased immune response and that makes us worry a little bit more, let's say.
'Maybe if he had a fever, it would have been better.'
The Vatican has given no indication of how long the pope might remain hospitalized, only saying that the treatment of such a 'complex clinical picture,' which has already required several changes in his drug regimen, would require an 'adequate' stay.
