On a cold night last December, Monsignor Kevin W. Vann arrived at St. John's Hospital in Springfield, Ill., and headed toward the emergency room.

The emergency room at St. John's is a familiar setting for Vann, 54. Before tending to patients as a priest, he worked there as a lab technician, helping doctors find answers through blood work.

"You would go into emergency room," he said. "You'd see dying, life and death ... suffering. That brought to the fore my relationship with God."

As a parish priest, Vann encountered more turmoil, pain and death than many of his peers. He waded through marriage annulment requests, fielded accusations of sexual misconduct by priests and was sometimes called on to deliver bad news to priests.

The tough assignments didn't go unnoticed. In May, the compassionate, by-the-book priest was named the third bishop of the Fort Worth Diocese, succeeding Bishop Joseph P. Delaney.

Even before he became a priest, Vann was seen as bishop material, said the Rev. Robert A. Porter, a priest at Immaculate Conception Church in Deer Lodge, Mont., and a classmate of Vann's in seminary.

Just three months after being ordained in 1981, Vann was sent to Rome to study canon law. Most of his fellow canon law students were seasoned priests.

Vann was in step with Pope John Paul II's strident opposition to abortion, euthanasia and, later, stem cell research. For Vann, those concerns superseded other moral issues, such as the war in Iraq and capital punishment. Last year, Vann suggested that he wouldn't give Communion to a U.S. senator with a pro-abortion-rights voting record.

By speaking out, Vann turned heads, said the Rev. Benedict J. Groeschel, an author, television personality and Vann's longtime friend. Groeschel added that Vann wouldn't be a bishop if not for his close adherence to the church's teachings.

Indeed, the opposition criticizes Vann for being a "company man." Michael Wegs, who also attended seminary with Vann in the late 1970s but who left before being ordained, calls Vann a church careerist.

Wegs, a member of Survivors Network of those Abused by Priests who lives in Minneapolis, is critical of Vann's decision to act as church attorney for a priest accused of sexual misconduct with a child.

He's presided over funeral Masses. He's held the hands of neglected and abused children in Fort Worth and spent a day with first-graders at an Arlington Catholic school. He's played piano for the Knights of Columbus in North Richland Hills. He's blessed a Fort Worth church, addressing in Spanish a standing-room-only crowd.

He has released information about a religious order priest in Denton removed because of accusations of sexual misconduct. He's gotten to know local university officials.

His job is big. The diocese has some 400,000 Catholics in 28 counties in North and Central Texas. Vann is also responsible for the diocese's 113 priests and 90 parishes.

And he's been doing what Delaney could not during his last two years as bishop: getting out. Delaney suffered from pancreatic cancer and underwent several surgeries that left him largely unable to perform his ministry.

Vann said that in May, when he stepped inside St. Patrick Cathedral in downtown Fort Worth for the first time, he thought: "I can't believe this is me. This is a huge responsibility. Life is crazy."

As a young man with a bent toward science, Vann was a lab technician in the mid-1970s at St. John's, the hospital where he was born. His mother had worked there as a nurse. He was engaged to a co-worker -- he had even bought the rings -- before breaking it off. But Vann's work sometimes troubled him, his mother, Theresa Vann, said.

"It showed him that life really is just a passing thing," she said. "Things can happen at any time and life can end. He saw that serious side of life in the emergency room."

"You'd have to go down and draw blood," Vann said. "Then you would have the doctors on the phone going, 'Where are the tests?' because people's lives depend on getting that stuff done and doing it right."

"How we are beginning now had not been my plan, nor that of Bishop Delaney, or many of us," Vann said then. "But this is the moment the Lord has given us."

The next day, at his Springfield church, Vann lamented how a priest's garb had come to symbolize mistrust. How truth would not be believed. He prayed to the archangel St. Michael to defend his people in battle: "Cast into hell Satan, and all of the evil spirits who prowl the world seeking the ruin of souls."

But others defend Vann by citing the thorny jobs he's taken. And they say he stands up and speaks the truth at the right time and place -- from the pulpit.

When he returned to Illinois in 1985 after studying in Rome, he went to work in a small parish and as a canon lawyer. The often messy marriage annulment cases taught him lessons about humanity.

In addition to consoling the beaten priest last December, Vann confronted him about allegations that he had offered his attackers, one of whom was a minor, money for a sex act.

In Decatur, Ill., Vann, who spoke Italian, celebrated Mass for local Hispanics over a dinner table at a Mexican restaurant. The after-hours service grew into the city's first Spanish Mass as Vann learned the language.

From the pulpit, he urged parishioners to carry their Catholic beliefs into the voting booth. He routinely announced his participation in Right to Life marches in Washington, D.C. And the parish newsletter urged parishioners to contact their state senators to lobby against a stem cell research bill.

Last year, Vann told a Springfield newspaper that he would be reluctant to give Communion to Sen. Dick Durbin, D-Ill., who had once attended Blessed Sacrament Catholic Church, where Vann was pastor.

Durbin's "pro-choice position puts him really outside of Communion or unity with the church's teachings on life. And that's why I would be reticent to give him Holy Communion," Vann told the State Journal-Register.

Vann became more serious as he has worked as the vicar for priests, said the Rev. Stephen Sotiroff, an Illinois priest and Vann's seminary classmate and friend.

"He's been exposed to a lot," Sotiroff said. "That's been good, and that's been bad. Good in the sense that he was able to help priests who were in distress. Bad as far as the scandals of the church were concerned."

But for some, Vann didn't take his work seriously enough. Stephen Brady of the Roman Catholic Faithful, an Illinois group, said he wrote to Vann in August 2004 urging him to look into allegations of homosexuality in the clergy. Earlier this year, in part because of such persistent rumors, the Springfield Diocese launched an open-ended investigation into any concerns about clergy misconduct, a spokeswoman said.

Vann didn't flinch when told of Brady's comments. He had written to Brady last year, encouraging him to document his allegations and urging him to contact law enforcement if he thought a crime had been committed.

"In my life, if I thought there was something I needed to say and do correctly, I do it," he said. "Not everybody always knows about it. But that's what I do."

On a summer day at St. Maria Goretti Catholic School in Arlington, a boy stood up and asked the bishop to bless a classmate whose back was hurt.

Expectations, from all corners of the diocese, are high. Vann said he doesn't shrink from the responsibility of being a successor to the Apostles.

Porter, his seminary classmate, said Vann is a deeply compassionate person. But his empathy is based on his beliefs, and sometimes he will not be popular.

"The things he believes and teaches, he really does believe and teach," Porter said. "As a consequence, we will not be in the mainstream. We will not be culturally aligned."

But in private, friends such as the Rev. John Titus of the Springfield Diocese have seen him angry and disappointed, especially when things hurt the church or people.

Vann, for instance, took the time to help Titus to a doctor's appointment after he complained of being ill. Titus was diagnosed with cancer and is now recovering.

Titus said Vann is a man of prayer who is devoted to the church's sacraments and who goes to confession on a regular basis. He sees a priest with a simple faith. Groeschel, Vann's longtime friend, sees his faith as direct and unskeptical.

Ask Vann to explain eternity, and he often refers back to the teachings of his childhood; he does the same for the meaning of life. "We're here on the earth to know, love and serve God and be happy with him in heaven," he said, reciting the lesson he learned in the first grade.

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