Hello! Welcome to the Mayo board. I also have stage 4 inoperable pancreatic adenocarcinoma. I was diagnosed in late March 2023 and staged 4/6/23. I can certainly understand all of your concerns. This disease is challenging, and fighting it is a real slog, day by day. It is difficult to keep spirits up. I'm glad your MD is in touch with the Johns Hopkins folks; that should help you get the appropriate treatment. But of course, you are always free to seek a second or third opinion elsewhere. Why did your wife change oncologists? I changed early in my treatment because my first oncologist, um, lacked bedside manner, let's say. (He was sharp and dismissive.) I also hope that you have some community support in your area and resources such as grocery delivery to help you manage everything. Please feel free to browse the board and research topics and post questions. I have found the people here to be so friendly and forthcoming, and I'm sure you will too.