Pope Francis marked Ash Wednesday on his 20th day in Rome's Gemelli hospital by taking part in the rite of the blessing of the ashes and receiving them in a short prayer service, the Vatican said.

While the 88-year-old pope's overall clinical case remained complex, his condition was "stable" and he did not experience any episodes of "respiratory insufficiency," the Vatican said in its evening medical bulletin March 5.The pope received ashes and the Eucharist in the morning from a celebrant, who was not named in the bulletin. It was most likely one of the hospital chaplains, a Vatican source said.

The rite was held in the private suite of rooms on the 10th floor of the hospital where the pope has been receiving treatment for double pneumonia and other respiratory ailments, the Vatican said.

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The pope was diagnosed with double pneumonia Feb. 18 after being admitted to the hospital Feb. 14 for breathing difficulties. A Vatican source said the pneumonia is following a "normal evolution" that is expected to be seen in someone receiving treatment. Each case is different and "patience is needed" because the illness "does not disappear in one day," the source said.

The pope is "in a good mood" and cooperative, the source added.

Pope Francis spent March 5 sitting in an armchair and increased the amount of "respiratory physiotherapy" he has been getting, which often consists of breathing exercises, as well as physiotherapy, the bulletin said. A source said a physiotherapist is working with him to help prevent any of the usual consequences that arise when a person has limited opportunities for movement while hospitalized.

"As scheduled, the pope receives high-flow oxygen" through a nasal cannula during the day, the bulletin said, and, at night, he wears a mask covering his nose and mouth for "noninvasive mechanical ventilation."

Although the pope no longer needed oxygen through a breathing mask during the day March 4 and 5, a Vatican source has said mechanical ventilation is used at night so he can sleep better.

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Also March 5 he telephoned Father Gabriel Romanelli, parish priest of Holy Family Church in Gaza, which, the source said, indicates the pope is able to talk. The pope spent the afternoon alternating between working and resting, the bulletin said.

Because of the continued complexity of his case, his doctors continue to hold that his "prognosis remains guarded."

The Vatican had said in the morning that the pope had rested well overnight and had woken up a bit after 8 a.m. It was the first time doctors had communicated the waking time of the pope, whose normal schedule had been waking as early as 4 or 5 a.m. for prayer and reflection.

Pope Francis had suffered "two episodes of acute respiratory insufficiency" March 3, which occurs when the lungs are unable to effectively take in sufficient oxygen or expel enough carbon dioxide to meet the body's needs.

Those crises led doctors to put the pope back on "noninvasive mechanical ventilation" -- a treatment that delivers air with added oxygen through a tightly fitted face mask and using positive pressure to assist breathing. He also underwent two bronchoscopies that day but "remained alert, oriented and cooperative at all times," the Vatican said.

Cardinal Angelo De Donatis, head of the Apostolic Penitentiary, a church court, led the traditional Ash Wednesday celebration that usually is presided over by the pope. The celebration March 5 began with a penitential procession from the Benedictine monastery of St. Anselm on Rome's Aventine Hill and to the Dominican-run Basilica of Santa Sabina, followed by Mass and the distribution of ashes.

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The cardinal read the homily prepared by Pope Francis, however, he prefaced his reading by saying, "We are deeply united" with the pope, and "we thank him for offering his prayer and his sufferings for the good of the whole church and the entire world."

The Vatican also announced that the pope would not be present for the March 8-9 Jubilee for Volunteers, and that the Mass March 9 would be presided over by Cardinal Michael Czerny, prefect of the Dicastery for Promoting Integral Human Development. About 25,000 people from more than 100 countries were expected to attend.Cardinal Marcello Semeraro, prefect of the Dicastery for Saints' Causes, was scheduled to lead the nightly recitation of the rosary for Pope Francis in St. Peter's Square March 5.