Pope Francis is back home after a 5-week hospital stay for life-threatening double pneumonia

VATICAN CITY — A frail Pope Francis returned to the Vatican on Sunday after a five-week hospitalization for life-threatening double pneumonia, and he made a surprise stop at his favorite basilica on the way home before beginning two months of prescribed rest and recovery.

The 88-year-old pope sat in the front passenger seat of his white Fiat 500L wearing nasal tubes to give him supplemental oxygen as he entered the Perugino gate of Vatican City, where his return brought relief after fears that his illness could be fatal or lead to another papal resignation.

Francis' motorcade from Gemelli hospital overshot the Vatican initially and took a detour across town to stop at St. Mary Major basilica, where the pope’s favorite icon of the Madonna is located and where he always goes to pray after a foreign visit.

He didn’t get out of the car but gave a bouquet of flowers to the basilica’s cardinal to place in front of the Salus populi Romani icon. The Byzantine-style painting on wood is revered by Romans and is so important to Francis that he has chosen to be buried in the basilica to be near it.

The tour through Rome’s historic center came after Francis made his first appearance in five weeks to give a thumbs-up and brief blessing from a hospital balcony. Hundreds of people had gathered on a brilliant spring Sunday morning to say goodbye and catch a first glimpse of Francis, who seemed to be gasping for air.

‘‘I see this woman with the yellow flowers. Brava!‘’ a bloated-looking Francis said in a breathless voice. He gave a weak sign of the cross before being wheeled back inside.

Chants of ‘’Viva il papa!‘’ and ‘’Papa Francesco'' erupted from the crowd, which included patients who had been wheeled outside just to catch his brief appearance.

Resting at home

Doctors say Francis needs two months of rest and convalescence at the Vatican, during which he should refrain from meeting with big groups of people or exerting himself. But they said he should be able to resume all his normal activities eventually.

His return home, after the longest hospitalization of his 12-year papacy and the second-longest in recent papal history, brought tangible relief to the Vatican and Catholic faithful who have been anxiously following 38 days of medical ups and downs and wondering if Francis would make it.

‘‘Today I feel a great joy," said Dr. Rossella Russomando, who was at Gemelli on Sunday but did not treat Francis. ‘’It is the demonstration that all our prayers, all the rosary prayers from all over the world, brought this grace.‘’

The Rev. Enzo Fortunato, who heads a papal committee dedicated to children, said it was clear that Francis was happy to return home and would surely improve, especially after receiving so many get-well cards from children from around the world.

‘‘If the first medicine was the affection of the children, the second medicine is definitely (going) home,‘’ Fortunato said. “It will certainly speed up his recovery.‘’

Pope is to receive 24-hour care

At the Vatican, where a Holy Year is under way, pilgrims cheered and applauded when Francis' greeting from Gemelli was broadcast live on giant TV screens in St. Peter’s Square.

‘‘For me it was an important emotional experience to see him, because many people were waiting for this moment,‘’ said Sister Luisa Jimènez, a nun from Francis' native Argentina.

Another nun from the same order, Colombian Sister Angel Bernal Amparo, expressed concern, given his bloating and inability to speak much.

‘‘He didn’t look well,‘’ she said. “He couldn’t (talk) and I realized it was because of his breathing and, well, he left right there. But I was glad to have seen him.‘’

No special arrangements have been made at the Domus Santa Marta, the Vatican hotel where Francis lives in a two-room suite on the second floor next to the basilica. He will have supplemental oxygen and 24-hour medical care as needed, although his personal physician, Dr. Luigi Carbone, said he hoped Francis would progressively need less and less assistance breathing as his lungs recover.

Two life-threatening crises

The Argentine pope, who has chronic lung disease and had part of one lung removed as a young man, was admitted to Gemelli on Feb. 14 after a bout of bronchitis worsened.

Doctors first diagnosed a complex bacterial, viral and fungal respiratory tract infection and soon thereafter, pneumonia in both lungs. Blood tests showed signs of anemia, low blood platelets and the onset of kidney failure, all of which later resolved after two blood transfusions.

The most serious setbacks began Feb. 28, when Francis experienced an acute coughing fit and inhaled vomit, requiring the use of a noninvasive mechanical ventilation mask to help him breathe. He suffered two more respiratory crises a few days later, which required doctors to manually aspirate ‘’copious'' amounts of mucus from his lungs, at which point he began sleeping with the ventilation mask at night to help his lungs clear the accumulation of fluids.

He was never intubated and at no point lost consciousness. Doctors reported he always remained alert and cooperative, although they say he has probably lost a bit of weight given a natural loss of appetite.

‘‘Unfortunately yes, there was a moment when many were saying that he might not make it. And it was painful for us," said Mario Balsamo, the owner of coffee shop in front of Gemelli. “Instead, today with the discharge, we are very happy that he is well and we hope he will recover soon and will recover his strength.‘’

‘I’m still alive!'

Dr. Sergio Alfieri, the medical and surgical chief at Gemelli who coordinated Francis' medical team, stressed that not all patients who develop such a severe cases of double pneumonia survive, much less are released from the hospital. He said Francis' life was at risk twice, during the two acute respiratory crises, and that the pope at the time understandably lost his typical good sense of humor.

‘‘But one morning we went to listen to his lungs and we asked him how he was doing. When he replied, ‘I’m still alive,’ we knew he was OK and had gotten his good humor back,‘’ he told a news conference late Saturday.

Alfieri confirmed that Francis was still having trouble speaking due to the damage to his lungs and respiratory muscles. But he said such problems were normal, especially in older patients, and predicted his voice would eventually return. Francis is also continuing to take medication to treat a more minor respiratory infection.

No confirmed appointments for now

Vatican spokesman Matteo Bruni declined to confirm any upcoming events, including a scheduled audience on April 8 with King Charles III or Francis' participation in Easter services at the end of the month. But Carbone said he hoped Francis might be well enough to travel to Turkey at the end of May to participate in an important ecumenical anniversary.

Only St. John Paul II recorded a longer hospitalization in 1981, when he spent 55 days at Gemelli for minor surgery and treatment of an infection.

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Associated Press writers Silvia Stellacci and Giada Zampano in Rome and Colleen Barry in Soave, Italy, contributed.

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