As a White House physician under three presidents, Ronny L. Jackson often went to extra lengths to win over the officials he was on hand to assist. He helped George W. Bush clear brush at his Texas ranch. He supplied Barack Obama with Nicorette gum even as he urged him to quit the nicotine substitute. He once was so eager to deliver a sling to Vice President Richard B. Cheney for a sore arm that his sprint toward the presidential helicopter caught the attention of Secret Service agents, a friend said.
That kind of enthusiasm drew ridicule in January, when Jackson said at a news conference that President Trump “might live to be 200 years old” if he had a more healthful diet. But his performance received lavish praise from the president, who shocked Washington a few months later by tapping the former combat surgeon to run the Department of Veterans Affairs — one of the federal government’s largest and most fraught bureaucracies.
The job would place Jackson — a Navy rear admiral who led a team of fewer than a dozen surgeons in Iraq and now heads a staff of 70 at the White House — atop an agency of more than 375,000 employees and a budget of more than $185 billion.
Jackson’s propensity to please puts him on a markedly different footing from that of David Shulkin, who was fired as VA secretary after battling with Trump appointees over the president’s agenda to outsource more veteran services to private providers. Jackson has told lawmakers that he opposes privatization. But because Jackson has little track record in public policy, his views remain largely a mystery, and some veterans advocates fear he would be inclined to follow his boss’s lead.
It’s “impossible” that Jackson could be up to speed about the demands of such a large organization, said Paul Rieckhoff, executive director of Iraq and Afghanistan Veterans of America.
Carl Blake, executive director of Paralyzed Veterans of America, said: “We still know very little about him at this point or his philosophy on key issues.”
Jackson, 50, declined a request for an interview. He has said that he never thought he would keep his job under Trump and that he did not seek the VA nomination.
He is preparing ferociously for the Cabinet post, colleagues say. This week, he began making the rounds on Capitol Hill ahead of his April 25 confirmation hearing, and he has welcomed a string of VA officials to the White House for hours-long briefings on the minutiae of the agency.
It is a show of the ambition that pushed him from a small town in Texas into the Navy, through years of training in emergency medicine and trauma surgery, and then into the White House.
There, he has had unmatched proximity to power — and learned to navigate it.
“He knows how to read a room really, really well,” said Sean Spicer, Trump’s first communications director, who like many presidential aides over the past 12 years spent hours with Jackson in motorcades, on flights and in the White House. “The thing that I think has been fascinating about watching him is that he really understands how to interact with people. He knows when to dial back and when to engage.”
Now, Jackson faces the ultimate test of that ability, and of whether it is enough to propel him into the biggest job of his career.
Jackson began his White House tenure in 2006 as part of a team responsible for caring directly for the president, his family and more than 7,000 employees.
He was just days into his new job when the vice president stopped by for help. Cheney was headed out of town and asked for a sling to rest his arm in flight.
“Ronny was new, and didn’t know where slings were kept, so he scrambled around looking for a sling,” recalled Capt. Thomas Craig, a fellow Navy doctor and longtime friend. “He found one and tore out of the White House running like a scalded dog toward Marine One to catch up with the POTUS and Dick Cheney.”
There was one problem, Craig said: “Nobody can just run up on the POTUS without getting into all kinds of trouble.” Agents stopped Jackson in his tracks — but not before he delivered the sling to Cheney.
Jackson became Obama’s personal physician in 2013, a role he retained with Trump. As he has at other moments of his career, he has offered an aw-shucks explanation for his success, claiming modestly to the Lubbock Avalanche-Journal in Texas this month that he “kind of got catapulted” to the top of the organization.
Much of Jackson’s work over the past 12 years at the White House has involved the routine repair work of a small-town practitioner, with a twist: giving flu shots, passing out cold medicine — and helping plan assassination contingency plans when the president leaves Washington. The job required extensive travel and hours of face time with the chief executive. Jackson has played basketball with Obama and spent time with Trump at his Florida home, Mar-a-Lago.
“It’s a very intimate job,” said Reggie Love, a former personal assistant to Obama who regularly rode with Jackson in flight and in the limousine that accompanies presidential motorcades. “Even when you’re in the middle of the desert in Riyadh, the guy’s got a smile on his face and he’s happy to be there.”
Love recalled Obama’s travel director, Marvin Nicholson, once hitting his head during a helicopter ride in Ghana. “Ronny stapled and glued him up. There’s no panic. There’s no like, ‘What are we going to do?’ ”
Jackson also stitched up Love’s chin once. “I think it was the night of the White House correspondents’ dinner,” Love said. “He said, ‘Good luck not getting your tuxedo bloody.’ ”
More than a dozen current and former colleagues interviewed for this article described Jackson as a popular colleague and an excellent doctor.
“He was a joy to be around,” said David Axelrod, who was an adviser to Obama.
One trait universally cited is Jackson’s storytelling ability. He has regaled colleagues with one particular tale about administering stitches on an intimate part of his body. He even recounted it for Bush after cutting himself with a hoe at the president’s ranch in Texas.
As he prepared to stitch up his leg, Bush protested. “It’s okay, I’ve sewn myself up before,” Jackson replied, then told the president about his earlier injury, according to people familiar with the episode. That earned him an admiring nickname from Bush: Scrote.
Most former colleagues demurred when asked about the doctor’s preparedness to lead VA.
Jackson “understands the stakeholders,” Love said. But addressing the department’s challenges is like “trying to move a battleship. It’s going to be a lot of work.”
At the White House, Jackson has been involved in few large-scale policy decisions beyond his role working on assassination preparedness and running the medical operation for big events such as the Group of Eight summit at Camp David in 2012. In Iraq, he led about eight doctors — and volunteered for the additional duty of helping new arrivals find housing at the sprawling Al-Taqaddum air base.
People who know him were taken aback by Jackson’s glowing praise for Trump’s health in the news conference this year. He described the president’s overall health as “excellent,” using nearly identical words he had written in a medical report about Obama four years earlier.
But Jackson went even further with Trump. “The answer to your question is that he has incredibly good genes,” Jackson responded to one reporter during the news conference, “and it’s just the way God made him.”
Critics accused him of playing to the sensitivities of a uniquely praise-hungry president, and even friends wondered about his choice of words that day.
“It wasn’t really Ronny,” Craig said.
The blood was often still warm from its donors when the surgeons at Al-Taqaddum in central Iraq pumped it into the wounded — as much as 40 pints into a single patient. Most of it bled back out onto the hospital floor, but it kept U.S. troops alive while they awaited their turn for surgery.
For eight months beginning in July 2005, Jackson led the emergency medicine unit at TQ, as it was known — a 24-hour operation. Sometimes it was two, sometimes 15. Most of the injuries resulted from improvised explosive devices, or roadside bombs.
“This guy risked his life for his country, he’s been out in the thick of it, he understands what war is all about, he’s had people die in his arms,” said Sen. Lindsey O. Graham (R-S.C.), who has known Jackson for a while and plans to introduce him at his confirmation hearing next week. “That’s what I want the next VA guy to understand. We’re not playing games here.”
According to Peter Rhee, a retired Navy captain, and other colleagues who served with Jackson, Al-Taqaddum was a combat-zone hospital where troops and civilians alike were taken because they were unlikely to survive the 20 or 30 extra minutes it would take to reach more extensive hospitals in Baghdad or Balad.
In the operating room, surgeons including Jackson sometimes had to slice open their patients from sternum to pelvis to find and stop internal bleeding — then send them on to one of the bigger hospitals without even closing the incision.
Craig, who serves at the Naval Medical Center Portsmouth, in Virginia, said troops who arrived with no hope of survival — legs blown off to the pelvis or with gaping head wounds — were heavily sedated and wheeled to the side. But TQ had a high survival rate — about 97 percent, he recalled. Wounded troops often described feeling grateful for arriving at TQ, because it meant they probably would be okay, he said.
Obama press secretary Josh Earnest, who spent hours on the road and in the White House with Jackson, said he can see the connection between the doctor’s work in combat and his later role in the White House. Both appeal to an excitement junkie.
“In some cases, that is treating soldiers under fire in a war zone, and in some cases, that is putting in place the arrangements to protect the life of the president of the United States as he’s traveling around the world,” Earnest said. “So I think there is a consistent thread of his personality that runs through all of this.”
It was Rhee who told Jackson about the appeal of presidential medicine in the mid-2000s, when Jackson was in trauma training under him in California. Rhee said he would recount stories about a short-term Navy assignment in 1998 accompanying President Bill Clinton to China. Rhee described the experience as exhilarating: first-class travel, a front-row seat to history, an up-close view of the personality of a president.
“I didn’t just see China; I got the presidential tour of China,” Rhee said.
Once he was at the president’s side, Jackson used his post to build relationships and champion issues of personal importance to him. He regularly accompanied Obama on his quarterly visits to Walter Reed National Military Medical Center to visit wounded troops. And he kept Obama apprised in the aftermath of the shooting of Rep. Gabrielle Giffords (D-Ariz.) in January 2011.
By then, Rhee had retired from the Navy and was leading the trauma department at the Tucson hospital where Giffords was treated. He said he received daily calls from Jackson wanting to know how the congresswoman was doing.
Rhee credits Jackson with his invitation to sit in the first lady’s box a few weeks later during Obama’s 2011 State of the Union address — and to attend a White House state dinner for the president of South Korea the following October.
Many of Jackson’s friends think that his political finesse and compelling wartime experience could be enough to win confirmation as the next VA secretary.
What happens after that, however, is less certain. Craig said he has spoken to Jackson in recent days about his intense preparations for his upcoming hearings.
“What I took from him is that it’s a sense of obligation to serve his country even more,” Craig said. “He’s not looking at it like he’s being thrown into a deep fryer. But you and I know that it’s just going to be a quagmire of pain.”
Seung Min Kim, Lisa Rein and Emily Wax-Thibodeaux contributed to this report.