Veterans Affairs Secretary David Shulkin arrives to testify on veterans programs before the Senate Committee on Veterans Affairs on March 21. (Jose Luis Magana/AP)

Veterans Affairs Secretary David Shulkin has lived in presidential purgatory for weeks.

The president has told a number of advisers that he wants to oust Shulkin, once a favorite in his Cabinet. But the White House has sent mixed messages publicly, and it remains unclear to what extent the secretary still has President Trump’s full trust. As recently as Monday, one White House aide declined to discuss Shulkin’s future while another told Fox News that the president had confidence in him “at this point in time.”

The uncertainty has left the leader of the federal government’s second-largest agency, its employees, and even senior White House officials wondering if Shulkin still officially speaks for VA. It has raised questions, too, about what’s being done to restore order at the agency after weeks of turmoil have left little doubt that Shulkin, the lone Obama administration holdover in Trump’s Cabinet, is next to go in what’s become a pronounced leadership shake-up.

What’s befallen Shulkin is a favorite tactic of Trump’s, who followed a similar approach with Secretary of State Rex Tillerson and, to a lesser degree, national security adviser H.R. McMaster. The president emasculates those who fall from favor, humiliating them through media leaks and in disparaging comments to friends. The mixed signals often leave even senior White House officials guessing who will be fired and when. 

“Anybody who tells you they know what he is thinking is out of their mind,” said Louise Sunshine, a former longtime Trump Organization executive. “He does not want anyone else to know what he is thinking ever. It is his way of keeping everyone on guard.”

For his part, Trump doesn’t mind it. When one adviser recently told Trump he should curb the firings and departures, he said they are “24-hour stories” and people quickly forget who held the jobs. 

While the president is displeased with Shulkin following a travel scandal and reports of a mutiny inside the agency, firing him has proven complicated for a variety of reasons.

For starters, it appears the White House hasn’t coalesced around a replacement. The president and his advisers are said to be weighing whether to remove the secretary and appoint an interim administrator or wait until they identify a permanent successor, according to administration officials. Either strategy would slow progress on Trump’s campaign pledge to reform the agency.

Moreover, the agency, with 360,000 employees, has proven one of the government’s most unforgiving bureaucracies to run. Its business model seems to impede innovation. Its pace of change is painstakingly slow. Its decentralized medical system is embroiled in crisis as the health-care needs grow among veterans of the wars in Vietnam, Iraq and Afghanistan.

But Trump’s mercurial management style may be the greatest hurdle to finding new leadership.

“I think he wakes up every day wondering if this is the day he’s going to get fired,” said one Shulkin ally, who requested anonymity because of the sensitivity of the issue. “He knows he is done,” although the uncertainty “is wearing on him, there is no doubt about that.”

Despite rumors of his ouster, Shulkin, who declined to comment, has kept a busy schedule, appearing on Capitol Hill, visiting VA hospitals and racing to complete a multibillion dollar project to modernize the agency’s antiquated medical records system. 

Those close to the secretary say he is unlikely to quit but wants to get the medical records contract signed before he is forced to leave, a deal he sees as key to his legacy.

His predicament is no doubt familiar to others once in the president’s inner circle.

During the last few weeks of Reince Priebus’s tenure as White House chief of staff, for example, he was so widely seen as weakened that some aides said they began skipping the meetings he called. Trump, meanwhile, told him he was doing a good job, even as other aides bet on how much longer he could survive. Trump eventually announced his replacement on Twitter minutes after Priebus walked off Air Force One onto a rainy tarmac.

In the case of Tillerson, foreign diplomats and prime ministers complained to U.S. lawmakers that they did not believe the secretary of state was speaking for the administration in the final six months of his tenure because Trump had so undercut him.

McMaster used to joke to other officials in the West Wing that any day could be his last and aides said his tenuous status kept him from doing his job.

Trump’s aides frequently ask him for the status of certain Cabinet officials so they will not say anything inaccurate publicly. Not checking frequently can leave an aide “looking dumb” with yesterday’s information, according to one former senior White House official. For instance, Trump told aides for several weeks that he was planning to oust McMaster. After a story said that, he told aides to deny it — and then moved to replace him less than a week later.

Trump will see a segment on TV and begin musing for someone in a job, creating uncertainty. For example, he saw Labor Secretary Alexander Acosta on “Fox & Friends” one morning and asked an aide if he could be the next attorney general. The president has, for months, attacked Attorney General Jeff Sessions, who has so far survived the public belittling.

Whether Trump was ever truly considering Acosta as attorney general is unclear; he will sometimes ask about five or 10 names a day for different jobs. 

Shulkin, say people close to him, is under no illusions that he still has the president’s confidence. He has long feared that Trump will mete out the same fate on Twitter as some of his former colleagues have. 

To that end, the secretary is laying low. He is limiting his travel to destinations close to Washington, canceling plans to speak next week at an annual ski competition for paralyzed veterans in Aspen, Colo. Shulkin is concerned, allies say, about the optics following an inspector general report that criticized a trip he led to Europe last summer.  

Shulkin has told those he trusts that he wants to avoid what happened to former FBI director James B. Comey, who learned of his firing last May from a television report while meeting with agents in Los Angeles. Trump wanted to fire Tillerson via tweet while he was traveling in Africa to maximize the humiliation, advisers say, but Chief of Staff John F. Kelly convinced him otherwise.

The distractions have hindered efforts to reform VA, agency officials say. The electronic-records contract has not been signed. Legislation crucial to the White House to expand veterans’ access to private doctors was left out of the government spending bill Congress passed last week after Democrats blocked its inclusion in the bill.

Shulkin’s weakened standing harmed his ability to forcefully advocate the administration’s position, observers say. Others contend Shulkin doesn’t fully support the administration’s desire for more private care. Moving forward, those involved in the negotiations say no one is certain who is speaking for the administration.

At VA, career officials try to avoid asking political appointees to make or sign off on decisions, since they don’t know exactly who is in charge or who they can trust, one current VA official said.

“The uncertainty from the White House has bled over to the VA and is jeopardizing the VA’s ability to serve our veterans,” said Sen. Jon Tester (Mont.), the top Democrat on the Senate Veterans’ Affairs Committee.

The White House faces another hurdle. The agency has few leaders who could take over on an interim basis, and Shulkin’s deputy, Thomas G. Bowman, is unlikely to get the nod because some White House officials have questioned his loyalty to the president’s agenda. 

Even in a less chaotic administration, the VA secretary oversees a decentralized bureaucracy of 360,000 employees who must be accountable to Congress and to veterans when health -are and benefits delays affect them. The oversight from lawmakers, who must agree before the agency can alter policy, can slow progress and frustrate leaders who come to the job expecting to make meaningful changes.

The turmoil and uncertainty over Shulkin’s future has left veterans’ advocacy groups, who represent one of Trump’s core constituencies, fearful that efforts to modernize VA will collapse. Many are impatient for the agency to address its many challenges, including recruiting for thousands of unfilled mental health, nursing and physician jobs.

Carl Blake, executive director of Paralyzed Veterans of America, said: “Clearly right now, the VA is caught in the middle of politics, but the challenge [of the secretary’s job] is just massive. What other federal agency has to deliver everything, from health care to education benefits to disability benefits to cemetery services?”

Said John Hoellwarth, a spokesman for AMVETS, “Imagine how daunting it must be to take this complex massive job in an administration that seems to enjoy firing people.”