Jeff,
I agree that all leaders face challenges similar to the ones you list and I have found that the best way to stay the course and be able to continue to push through when things are not going well is to ensure you are taking the path that aligns with your ethical and moral compass.  This is not usually the way that guarantees quick results and that sometimes becomes the issue.
We have become so enamored with instant results that leaders are often forced to make decisions that will not produce sustainable change but will give a quick bump to the P&amp;L or the next quarterly earnings report.  Then it becomes the challenge of continuing to prop things up with another set of temporary decisions quarter after quarter because that way you stay in the role.
It is a true challenge to actually disturb a system and try to harness the energy the disturbance creates in a positive manner to move the system forward while still producing the economic results needed.
Thanks for the thought provoking post.