In normal times, the average American’s experience with the U.S. surgeon general amounts to reading the warnings on a packet of cigarettes or a bottle of alcohol. But in the age of the novel coronavirus, Surgeon General Dr. Jerome Adams has become a regular presence in living rooms—and, recently, not always the most reassuring one.

On March 8, the first time many Americans saw Adams, the 45-year-old sat for an interview with CNN’s Jake Tapper. Adams, who holds the rank of vice admiral in the U.S. Public Health Service Commissioned Corps and oversees 6,500 public health officers, explained the nature of coronavirus to Tapper as if he was one of his anesthesiology patients. But as Tapper pressed on to more political ground—whether the age of former Vice President Joe Biden, Sen. Bernie Sanders (I-VT), and President Donald Trump meant they should stop campaigning in person—Adams careened off message.

“Speaking of being at risk, the president, he sleeps less than I do, and he’s healthier than what I am,” responded Adams, 46, who cuts a trim and athletic figure and runs 5Ks.

His claim did not pass the eye test.

Back in Indiana, where Adams served as public health commissioner under then-Gov. Mike Pence during some of the state’s most tumultuous health crises, at least one former aide arched his eyebrow when he watched the interview, texting Adams to see if he was serious.

He was.

“He realized that it came off poorly, but the president’s doctor came out and said he’s on one medication,” said the friend and former aide, who requested anonymity because he wasn’t authorized to speak on behalf of the surgeon general. “Adams is on six medications for chronic conditions—pre-diabetes, asthma, for example. From just a burden of chronic disease standpoint, it was accurate.”

But if Adams realized he had stumbled, it didn’t seem to alter his approach in subsequent media appearances. More than a week later, in an interview with Fox and Friends, Adams wrongly suggested that South Korea was an authoritarian nation. “We are not an authoritarian nation, so we have to be careful when we say, ‘Let's do what China did. Let's do what South Korea did,’” Adams said of the U.S. ally. (South Korea is a democratic republic.)

On Wednesday, he was asked by NBC’s Savannah Guthrie whether the U.S. could meet the demand for ventilators. “The best way to not run out of ventilators or [personal protective equipment] is to make sure you drive down demand,” Adams responded, discussing the virus in terms that implied people were pursuing—not avoiding—it.

And that’s not to mention a discordant chiding he gave reporters in a March 14 briefing: “No more criticism or finger-pointing,” Adams told the assembled press, playing media critic instead of the anesthesiologist he is.

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“In a few sentences, that took away so much of his credibility,” said Leslie Dach, who helped run Barack Obama’s response to the Ebola crisis while at the Department of Health and Human Services. “It shows how much this president can corrupt the integrity of people when they choose to be part of his political strategy instead of doing the job they took an oath to do. To be up there in that uniform is a disgrace.”

Dach pointed to Adams’ comments on March 8 in a CNN interview during which Adams said he felt good “pretty good that some parts of the country have contained” the virus. “It was unknowable at the time,” Dach said. “He gave people information that made more people more sick.”

“The surgeon general is a revered person for the truth in health care,” said Dach, who worked with Adams’ predecessor, Dr. Vivek Murthy. “Here we have someone who both politicizes the role and allows himself to be seen that way.”

A spokesperson for Adams was not available for comment. But for half a dozen friends, public officials and top aides who worked with Adams in Indiana when he was health commissioner something certainly seems off.

In their telling, Adams is an affable and intelligent political operator with a doctor’s bedside manner—a conservative who isn’t afraid to go where the science points. The recent high-profile missteps, they say, are uncharacteristic of the brilliant and poised anesthesiologist with degrees from the University of Maryland, the University of California at Berkeley, and a medical degree from the Indiana University School of Medicine.

But even then, they’re willing to cut him some slack. After all, the job that Adams is now assuming is of a different magnitude than anything a surgeon general has confronted before.

“If those are the worst examples that you got then he certainly continues to earn my respect,” said Dr. Woody Myers, a Democratic gubernatorial candidate in the Hoosier state who also served as public health commissioner during the 1980s. Myers, a former member of President Ronald Reagan's Commission on the HIV Epidemic who as public health commissioner supported Ryan White, the Indiana teenager and AIDS victim, counseled Adams during the 2015 HIV outbreak in Scott County, Indiana. “I listen to what he says. I know that what he's tried to do is right for the people. He’s the nation's top clinical doctor. I think that he’s an exceptionally bright physician who understands the pivotal role that he plays.”

Joey Fox, Adams’ former legislative director in Indiana, chalked up Adams’ lecturing the media to frustration. “My guess is that as the public health official he was frustrated by what he was seeing,” Fox said. “He wasn't making a blanket statement on all the media.”

An HHS spokesperson Secretary Alex Azar believes the surgeon general plays an important role in “communicating with the American people, educating them on appropriate measures to protect against viral infections, and calming fears.” Adams, the spokesperson said, “has been involved with the Secretary’s briefings for weeks and the Secretary has always been supportive of the Surgeon General’s advisories and initiatives.”

Adams grew up on a farm in Mechanicsville, Maryland. His younger brother, Phillip, would go on to develop substance use disorders, which Adams has said led him to make the opioid crisis—and the use of naloxone, a drug that can reverse an overdose—a defining agenda item of his time in office. In the rural county where he was raised, there were few doctors, and the profession appealed to him. He won a Meyerhoff Scholarship, a grant for minority students interested in the sciences that paid for his undergraduate tuition. Before medical school, he applied for a job at Eli Lilly, the Indianapolis-based pharmaceutical giant where Health and Human Services Secretary Alex Azar was once a senior executive.

In 2014, then-Gov. Pence appointed the oft-bowtied Adams—who at the time was only 40—as the state’s health commissioner. Adams would later say he had reservations about taking the role. “The rumor was he was old school—and not like the pop culture old school that the kids talk about, but older-super-conservative-from-southern-Indiana old school,” Adams said during his swearing-in ceremony in the vice president’s ceremonial office. The two went on to build a solid rapport, aides to both say.

On his first day in office in Indiana, Adams found himself thrust into the middle of efforts to prevent the spread of Ebola (there were no cases in Indiana, but Adams coordinated the state’s preparedness program, including ensuring the state had enough personal protective equipment and helping Indiana University Health to build an Ebola room to treat potential victims). He often worked 90 hours a week in Indianapolis, taking shifts at Eskenazi Hospital in addition to his duties as the state’s top doctor. He also served as a clinical associate professor of anesthesiology at Indiana University. On Saturdays, it was not uncommon for him to come into the office toting his three children—Caden, Eli, and Millie—who drew on the office whiteboard.

His tenure would be marked by two other public health crises. The first was dealing with the aftermath of the East Chicago lead crisis,—an EPA Superfund site was contaminating young children. Adams made numerous visits to both East Chicago and Scott County from Indianapolis to visit with Hoosiers, often having aides tune the radio to country music while talking Colts football. “He has really good small ‘p’ political skills—how to message things and get things done,” Fox said.

Once, Eric Miller, his chief of staff, recalls Adams encountering a young boy in East Chicago who was afraid of a blood draw a nurse was trying to administer. Adams intervened, entertaining the kid, gaining his trust, and drew the blood himself.

The second crisis that landed on Adams’ lap drew national attention. Under Pence’s governorship, Indiana witnessed a spike in HIV diagnoses following the decision to end needle exchanges. Adams worked to convince Pence that establishing a syringe exchange was necessary to prevent the diseases’ spread in rural Indiana where injection drug use of the prescription painkiller Opana—and needle sharing—had led to a cluster of more than 200 infections in the spring of 2015.

The job presented its share of tricky political and racial hurdles. Pence was steadfast in his religious beliefs and they often could present complications for public health policy.

“There were others in the administration who said we couldn’t even talk about [a needle exchange] because Gov. Pence wouldn’t even allow it,” said Art Logsdon, a former newspaper reporter who became the assistant commissioner of public health under Adams. But Adams and his deputy, Jennifer Sullivan, made the case. “They were the white knights,” Logsdon said.

There was also Indiana’s history that Adams had to confront. On one trip together, Fox was sitting shotgun when they passed a Confederate flag—not an unusual sight in Southern Indiana. Those in the car grew quiet as Adams looked out the window. “They are still our people that I’m in charge of taking care of,” Adams said.

In making the case for a needle exchange and earning opioid users' trust, Adams often shook hands with and hugged the people of Scott County. “A black guy in a largely rural community, all white, first of all being willing to communicate? He would dive in,” Logsdon said. “He’s not an officious kind of guy.”

When the White House needed to fill the surgeon general’s post, Adams was a logical option, owing to the relationship he had developed with Pence.

Inside the vice president’s ceremonial office on Sept. 5, 2017, Pence swore in Adams as the 20th surgeon general. In his remarks, Pence cited his experience as an anesthesiologist at Eskenazi Hospital in Indianapolis, and his time as a clinical associate professor of anesthesiology at IU, calling him “highly qualified not just to serve, but to succeed on behalf of the American people.” Pence also extolled Adams' work on everything from Indiana's infant mortality rate to prepping for the Ebola virus, saying Adams "calmed the waters in Indiana.”

Adams’ relationship with Pence—and their experience working together in Indiana—also made him an obvious addition to the coronavirus task force. As the surgeon general, his purview extends to infectious diseases, and allies say his bedside manner could ease an anxious nation. “It makes me feel a lot better when I go to sleep at night knowing that Dr. Adams is on the coronavirus task force," said Miller, his former chief of staff at the Indiana State Department of Health. “Because if there's somebody who is going to do the right thing, no matter what, it's Dr. Adams.”

Adams hadn’t been central to the administration’s response to the coronavirus until late February, when Vice President Pence added him to the task force the same day he tapped Treasury Secretary Steven Mnuchin and Director of the National Economic Council Larry Kudlow.

“He’s a no-drama, team player,” says a former Trump administration official who worked with Adams both in Indiana and D.C. “Humble, still a regular guy who is helping out because it’s the right thing to do. He’s not out for personal glory.”

But the challenge Adams faces now, guiding a worried nation through the throes of a pandemic, is unlike anything he’s faced before. And some of his friends and former aides can see the stress showing.

“No longer is he just in Indiana doing a press conference with Gov. Holcomb or Gov. Pence,” Logsdon said. “Now, the whole wide world is watching him. I watch him on T.V. He has a very serious demeanor about him. But I don’t know exactly what's going on. He’s not nearly as serious of a guy, normally. I don't know if he’s tired, or what. Between you and me, when you're in those jobs, you can’t be 100 percent candid. You have to adapt. You’re expected to adopt a certain line. But you’ve still got your own conscience.”

Trump has praised Adams’ turn as a new messenger for the administration on the coronavirus. “We’ve created a number of new stars, including the gentleman right behind me. I watched him the other day. It was such a fantastic job you did, and I really appreciate it,” Trump said of Adams at the March 14 White House news conference.

To Logsdon, Adams comes across as the same guy he worked with for three years in Indianapolis. “The Jerome Adams of 2014 to 2017 is pretty much the Jerome Adams of 2020—to the extent he chooses to be and to the extent he’s allowed to be,” Logsdon said.