Pope resting after sleeping through the night with a ventilation mask as he battles pneumonia

Pope Francis increased his physical therapy with his condition remaining stable on Wednesday, marking the start of Lent by receiving ashes on his forehead and calling the parish priest in Gaza, the Vatican said.

The Holy Father suffered no respiratory crises during the day, receiving oxygen through a nasal tube as has been the case in recent days. He will resume the use of a non-invasive mechanical mask for the night.

Doctors treating the pope for double pneumonia underlined that his prognosis remained guarded due to the complex picture. The 88-year-old pope, who has chronic lung disease and had part of one lung removed as a young man, had two respiratory crises on Monday in a setback to recovery.

During the morning he participated in an Ash Wednesday celebration, receiving ashes and Holy Communion. He later set to work, which included a call to the Rev. Gabriel Romanelli, the Argentine priest who is the parish priest of the Holy Family church in Gaza. It was the third time they have spoken since the pope was hospitalized Feb. 14.

The evening health bulletin carried the first mention of physical therapy for the pope, in addition to respiratory therapy, and the Vatican said it was to ensure no other negative impacts from the longest hospitalization of his papacy.

Vatican opens Lent

The Catholic Church opened the solemn Lenten season leading to Easter on Wednesday without the participation of Pope Francis, who is in the third week of hospital treatment for double pneumonia.

A cardinal took the pope’s place leading a short penitential procession between two churches on the Aventine Hill, and opened an Ash Wednesday homily prepared for the pontiff with words of solidarity and thanks for Francis.

“We feel deeply united with him in this moment,” Cardinal Angelo De Donatis said. ”And we thank him for the offering of his prayer and his suffering for the good of the entire church in all the world.”

Ash Wednesday

Lent begins with Ash Wednesday and leads up to Easter on April 20. A cardinal has been designated to take Francis’ place at Vatican celebrations.

On Ash Wednesday, observant Catholics receive a sign of the cross in ashes on their foreheads, a gesture that underscores human mortality. It is an obligatory day of fasting and abstinence for Catholics that signals the start of Christianity’s most penitent season.

“The condition of fragility reminds us of the tragedy of death,″ De Donatis said in his homily. ”In many ways, we try to banish death from our societies, so dependent on appearances, and even remove it from our language. Death, however, imposes itself as a reality with which we have to reckon, a sign of the precariousness and brevity of our lives.”

The pope was supposed to attend a spiritual retreat this weekend with the rest of the Holy See hierarchy. On Tuesday, the Vatican said the retreat would go ahead without Francis but in “spiritual communion” with him. The theme, selected before Francis got sick, was “Hope in eternal life.”

Prayers of support

Yuris Asis, visiting from Colombia, said he prayed for the pope “because his current condition, which is serious. All of the Catholic community around the world is praying for him.”

Italian Emanuele Di Martino said the pope was utmost in his mind as he experienced the pilgrimage to the Vatican.

“We hope that the pope’s health issues can be resolved because unfortunately the condition is not the best, but we hope and we trust that he will get well, if possible,” Di Martino said.

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Associated Press writer Colleen Barry and visual journalist Trisha Thomas contributed to this report.