WASHINGTON -- White House chief of staff Denis McDonough was ready to vent.
"I've had too much humble pie," he fumed, striding into a top aide's West Wing office. "That was the last slice. I'm full."
Mr. McDonough had just finished another hand-holding meeting with advocates anxious over the disastrous rollout of the health care law. For weeks, President Barack Obama and White House officials had been apologizing for and promising fixes to a faulty website and an unmet promise to insurance holders that they could keep their policies.
Mr. McDonough's message: It was time to change tactics, quit lamenting the problems and start emphasizing the health care overhaul's benefits.
When Mr. Obama assembled his second-term team last January, his new chief of staff promptly put his energetic stamp on things.
He increased White House outreach to lawmakers, worked to rebuild relations with the Cabinet and stepped up contacts with business leaders.
Ten months later, Mr. McDonough is trying to manage one of the roughest patches in Mr. Obama's presidency, as the White House labors to explain how the president got blindsided by the problematic enrollment launch of his health care law. As the president's gatekeeper, Mr. McDonough is at the center of the maelstrom, the man charged with deciding what the president needs to know and when.
With his periodic treks to the Capitol and his credentials as a former Senate staffer, Mr. McDonough has built a deep reserve of good will among lawmakers from both parties. But the botched health care rollout has angered many Democrats, who wonder why the White House did not see the trouble coming.
Mr. McDonough is now holding evening meetings daily with key players in the health care rollout, offering support even as he holds agency leaders accountable.
"We went straight into problem solving," he said last week during a stroll on the White House South Lawn.
"We knew that going into this, that no plan survives first contact. We knew that we would be confronted with challenges along the way. We are focused on getting it working, absolutely, and we're making good progress on that."
How the health care website performs on Dec. 1 and beyond will be an acid test of Mr. McDonough's leadership and crisis management. Still, the debacle has been damaging. Mr. Obama's public approval and his ratings for honesty and strength have sunk, and his personal favorability numbers have been leaning negative.
All that has raised panic in Democrats, who fear the consequences in next year's mid-term elections. Aware of the anxieties, Mr. McDonough meets every other week with more than a dozen Democratic senators up for re-election in 2014.
And though aides say he is devoting 70 percent of his time to health care issues, he says he's also focused on advancing the president's economic agenda, the overhaul of immigration laws and working to address college affordability and climate and energy issues.
"Denis takes everything personally. Nobody is going to be harder on Denis than himself," says Ben Rhodes, deputy White House national security adviser. "He was angry, frustrated, all of the above. If there is a problem, it is his personal mission to fix it, even if it is beyond his direct capacity to do so."
Of all the chiefs of staff who have worked for Mr. Obama, Mr. McDonough, 43, has the closest relationship with the president. Until the president named him chief of staff in January, he had been a foreign policy specialist and had served as deputy national security adviser.