Young and enthusiastic when he became Pope in the late 1970s, Pope John Paul II has been a picture of pain and suffering in the past years, a fragile man with shaky hands and an unsteady voice.

The 84-year-old Polish pontiff has been willing to expose his agony for all the world to see – sending a message of dignity, bravery and acceptance of what life can give.

As the Pope was taken to hospital for the second time in three weeks with respiratory problems, the Vatican newspaper wrote that he was sharing Christ’s suffering and said “the bed of pain” has become “the cathedral of life.”

It is the message the Catholic Church has been making as a pope once called “God’s athlete” has progressively got weaker physically over the past decade, hampered by Parkinson’s disease and knee and hip ailments.

Some question, however, how long could a pope once so active guide the one billion Catholic faithful when he can hardly talk and walk?

The Pope’s ill-health has been watched by the world and several images come to mind.

During a pilgrimage to Lourdes last August he trembled and asked for help, calling out in his native Polish. Back in 1999, during a visit to Georgia, cardinals formed a buffer to protect the shivering pontiff from the wind.

“It is a representative image, rather beautiful, of what is solidarity in the Church,” Vatican Radio said at that time.

Suffering may be unfamiliar to many, but the concept was the idea behind Mel Gibson’s film The Passion of the Christ, a box office success. The film was sanctioned by several top Vatican cardinals and was watched by the Pope, although the Vatican denied he had expressed his consent.

The Pope’s view on agony has another side to it, as he forcefully pointed out in a recent message for Lent that included a condemnation of euthanasia.

The commandment “Thou shalt not kill,” he said, “applies even in the presence of illness and when physical weakness reduces the person’s ability to be self-reliant.”

Inevitably, the Pope’s physical deterioration raises questions about how long he can steer the Church, particularly considering his mobility and speech problems.

The much-travelled pontiff has already been reducing his trips abroad, with only an August pilgrimage to a Catholic youth festival in Germany on his programme this year. While trying to keep up with his audiences, even during his recent convalescence, he has been leaving more and more of Vatican work to others.

Last week’s tracheotomy has further weakened the Pope, although it may have prolonged his life. It was performed to improve the efficacy of his breathing by being able to suck the secretions off his chest and allow them to get on top of any infection that he has.

The operation, performed under general anesthetic, creates a convenient opening that bypasses swelling in the throat. It allows doctors to get suction tubes down to the lungs to lift mucus off the chest to prevent infection and allow air to get to the right parts of the lung so that it oxygenates the blood better.

The problem remains as to when the Pope will be able to speak again and what will happen when his condition, as is common in people with Parkinson’s, continues to deteriorate. Some have suggested that he may still be able to carry out his job in writing, but others are hinting that it is perhaps time for him to think of abdicating, leaving the Church in other hands.

The Pope’s resilience and strong will have so far stopped him from doing so. But for how long can he continue to run the Church?