Why Am I the Fourth?
- Jul 9
- 8 min read
Why Am I the Fourth?
By Holly Gernatt BSN, RN, CCRN, Flight Nurse Educator
For years, I had heard the phrase:
“Jesus is the fourth pressor.”
As an ICU nurse and now a flight nurse, I understood exactly what it meant. In critical care, when a patient is profoundly unstable and the blood pressure continues to fall, we reach for medications called vasopressors to help support circulation. Levophed is often started first. Vasopressin may be added. Then epinephrine. We titrate. We reassess. We troubleshoot. We draw labs, administer fluids or blood when indicated, search for reversible causes, and continue doing everything within our ability to save the life entrusted to us.
And when three pressors are hanging and the blood pressure is still falling, someone may say:
“This patient needs Jesus.”
Or:
“Jesus is the fourth pressor.”
For a long time, I understood the sentiment behind those words. When medicine reaches its limits, when our knowledge has been exhausted, and when every human intervention has been attempted, there is an acknowledgment that the outcome ultimately rests in hands greater than our own.
But years later, as my own relationship with Jesus deepened and I spent more time in prayer, Scripture, and quiet reflection, that phrase began to weigh differently on my heart.
I found myself thinking about it again.
Jesus is the fourth pressor.
And in a time of deep prayer and meditation on God's Word, I felt the Holy Spirit impress a question upon my heart:
“Why am I the last and not the first?”
It stopped me.
Why is Jesus fourth?
Why do we wait until the medications are hanging, the interventions have been exhausted, the blood pressure continues to fall, and we've reached the limits of what human hands can do before we call upon Him?
Why do we make Jesus our last resort instead of our first response?
The more I reflected on that question, the more I realized this wasn't really just about the ICU.
It was about how we live.
We all have our own pressors.
The Pressors We Reach for in Life
When life begins to fall apart, we instinctively reach for whatever we believe might stabilize us. We call a friend. We ask our family what they think. We search Google. We scroll social media. We listen to podcasts, read books, seek professional opinions, and replay the situation over and over in our minds.
We worry. We analyze. We strategize. We try harder. We try to control.
One intervention doesn't work, so we add another.
Then another.
And only when nothing else has stabilized us do we finally bow our heads and pray.
Jesus becomes our fourth pressor.
The last intervention.
The final consultation.
The One we call upon when everything else has failed.
But He was never meant to be fourth.
He was always meant to be first.
The Enemy Doesn't Always Need Us to Abandon Jesus
This is where I believe the deception becomes especially subtle.
The enemy does not always need to convince us to stop believing in Jesus. Sometimes he only needs to convince us to put Jesus last.
We can still call ourselves Christians. We can attend church, own a Bible, pray before meals, listen to worship music, and proclaim that Jesus is Lord. Yet when fear comes, confusion sets in, a major decision must be made, or life begins to unravel, Jesus can quietly become the last One we consult.
The enemy doesn't necessarily need to remove Jesus from our lives if he can simply move Him to the end of the line.
Because when Jesus is last, something else is first.
Our fear. Our own understanding. The opinions of others. The culture. The internet. Our desire for control. The wisdom of the world.
Perhaps one of the enemy's quietest victories is not convincing a Christian to reject Jesus altogether, but convincing a Christian to seek Him only after everything else has failed.
Scripture tells us:
“Trust in the LORD with all your heart; do not depend on your own understanding. Seek his will in all you do, and he will show you which path to take.” — Proverbs 3:5–6
Yet how often do we reverse that order?
We depend on our own understanding first. We ask everyone else second. We search the world for answers third.
And then we acknowledge Him.
Jesus becomes fourth.
We Have Been Conditioned to Reach Outward Before We Reach Upward
We live in a world built around instant answers. If we have a question, we search for it. If we have a symptom, we look it up. If we need advice, we ask someone. If we feel uncertain, we seek reassurance. If we have a problem, we immediately begin searching for a solution.
There is nothing inherently wrong with seeking information, asking for wise counsel, receiving medical care, learning from others, or using the resources available to us. Scripture itself affirms the value of wise counsel.
The issue isn't whether we seek help.
The issue is order.
Who do we seek first?
Who gets the first word?
Who has the highest authority?
Who shapes the way we interpret everything else we hear?
I have had to ask myself whether we have become so conditioned to rely upon the world that turning to Jesus now requires conscious effort. For many of us, I believe it does. We have to intentionally retrain our hearts to reach upward before reaching outward—to pray before panicking, to seek before searching, to listen before reacting, and to ask God for wisdom before asking everyone else for an opinion.
Because our natural instinct may be to grab the phone.
But our spiritual discipline must become going to the Father.
James tells us exactly where to go when we don't know what to do:
“If you need wisdom, ask our generous God, and he will give it to you.” — James 1:5
Ask God.
Not eventually.
Not when every other answer has failed.
Ask Him first.
Scripture Doesn't Tell Us to Seek God Eventually
Jesus was very clear:
“Seek the Kingdom of God above all else, and live righteously, and he will give you everything you need.” — Matthew 6:33
First.
Not fourth.
Not eventually.
Not after we have exhausted every other option. Not after we've worried ourselves sick. Not after we've asked everyone else. Not after the world has failed us.
First.
This pattern runs throughout Scripture. Proverbs tells us to trust in the Lord rather than leaning on our own understanding. James tells us that when we lack wisdom, we should ask God. Paul tells us that when anxiety rises, we should bring everything to God in prayer:
“Don't worry about anything; instead, pray about everything. Tell God what you need, and thank him for all he has done.” — Philippians 4:6
And Jesus tells us plainly:
“Apart from me you can do nothing.” — John 15:5
Throughout Scripture, the pattern is clear.
Seek Him. Trust Him. Ask Him. Acknowledge Him. Abide in Him.
First.
What Are Your Pressors?
The more I reflected on this, the more personal the question became.
What are the things I reach for when I feel like I'm losing control?
What do I use to stabilize myself before I go to Jesus?
Maybe your first pressor is another person's reassurance. You need someone to tell you that everything is going to be okay.
Maybe it's Google. You search until you find an answer that calms your fear.
Maybe it's social media, work, food, shopping, exercise, achievement, entertainment, or staying constantly busy so you don't have to sit quietly with what you're feeling.
Maybe it's control. You plan, organize, anticipate, and prepare for every possible outcome because uncertainty feels unbearable.
Not all of these things are inherently wrong. Some are good gifts. Some are necessary resources. Some are people God has intentionally placed in our lives.
But even good things can become misplaced sources of dependence when we reach for them before we reach for God.
So perhaps the question isn't simply:
Do I believe in Jesus?
Perhaps the more revealing question is:
Where does Jesus fall in the order of whom I seek?
When fear comes, where do I go first? When I don't know what to do, whom do I ask first?
When I need reassurance, where do I look? When I'm hurting, where do I run? When I face a decision, whose voice do I seek before all the others?
Because believing in Jesus and seeking Jesus first are not always the same thing.
What If Jesus Became Our First Response?
What would change if prayer wasn't our last resort?
What if, before searching the internet, we prayed? Before asking five people what they thought, we asked the Lord for wisdom? Before fear was allowed to write the story in our minds, we opened God's Word? Before trying to control the outcome, we surrendered it? Before the noise of the world filled our minds, we gave Jesus the first word?
This doesn't mean God will always give us an immediate answer. It doesn't mean every decision will suddenly become easy. And it doesn't mean we won't still need doctors, counselors, pastors, trusted friends, teachers, or other forms of wise counsel.
God often works through people.
But there is a difference between allowing God to use people and allowing people to take God's place. There is a difference between seeking counsel and surrendering our discernment. There is a difference between using the world's resources and allowing the world to become our authority.
Jesus should not simply be one voice among many.
He should be the voice by which every other voice is tested.
Before the First Pressor
This brings me back to the bedside.
As a flight nurse and critical care nurse, when a patient is crashing, I don't believe we should stop treating and simply pray instead. Faith does not call us to abandon the knowledge, medications, skills, and resources God has given us.
We assess. We intervene. We give the medication. We hang the pressor. We titrate the infusion. We follow the evidence. We use our training. We communicate with the team. We do everything within our ability to care well for the person entrusted to us.
But what if Jesus didn't have to wait until the fourth pressor?
What if we prayed before the first one was ever hung?
What if we silently asked for wisdom as we entered the room? What if we prayed for discernment while reading the monitor? What if we asked God to steady our hands, sharpen our minds, guide our decisions, and help us see the person beneath the diagnosis?
What if Jesus wasn't simply the One we called upon when medicine had nothing left to offer?
What if He was present in our hearts from the very beginning?
Colossians 3:17 reminds us:
“And whatever you do or say, do it as a representative of the Lord Jesus, giving thanks through him to God the Father.”
Whatever we do.
Even at the bedside.
Even in the back of an ambulance.
Even in a helicopter thousands of feet above the ground.
Even in the ICU at three in the morning with alarms sounding and three pressors running.
Jesus doesn't have to be our fourth pressor.
He can be present before the first.
Why Am I the Fourth?
I still think about that phrase:
Jesus is the fourth pressor.
And I understand the message behind it. When medicine has reached its limits, Jesus is still there. When every intervention has been attempted and every human answer exhausted, He remains faithful. When we reach the end of ourselves, He doesn't turn us away.
There is grace even when we come to Him last.
But I can't forget the question I felt impressed upon my heart during that time of deep
prayer:
“Why am I the last and not the first?”
And perhaps that is a question worth asking all of us.
Why do we so often give the world the first opportunity to answer questions that should first be brought before God? Why do we allow fear to speak before prayer? Why do we seek reassurance before seeking His presence? Why do we search everywhere else before opening His Word?
The enemy does not always need to convince us to abandon Jesus.
Sometimes he only needs to convince us to put Him last.
And that is why seeking Jesus first must become intentional. The world will always be loud.
The notifications will always come. The opinions will always be available. The search bar will always be waiting. The voices will always compete for our attention.
But Jesus still says:
Seek first.
So perhaps the next time life becomes uncertain, fear rises, a difficult decision lies ahead—or the next time the monitor alarms, the blood pressure drops, and we reach for another pressor—we can interrupt our usual pattern.
Before we search. Before we scroll. Before we call. Before we worry. Before we try to control.
We can pray.
Because Jesus was never meant to be the fourth pressor we reach for when everything else fails.
He was always meant to be first.
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