Although individual cases vary, generally on the last day of treatment a child in remission from leukemia has a diagnostic spinal tap, a bone marrow aspiration, a complete blood count and chemistry screen, a thorough physical exam, and a discussion with the oncologist. The oncologist should review the treatment, outline the schedule for blood tests and exams for the future, and sensitively inform the family of the potential for long-term side effects. After the procedures, the family will usually wait to hear the preliminary report on the bone marrow aspiration, as true relief does not come until they hear that no leukemic blasts are present.
One group of parents presented to physicians at a major children's hospital the following list of suggestions for the last day of treatment:
Schedule enough time to have a conversation.
Bring a sense of closure to the active phase of treatment.
Express happiness that all has gone well.
Be realistic but hopeful about the future.
Praise the child for handling a very difficult time in her life with grace (or courage, or whatever word is appropriate).
Praise the parents for all of their hard work.
Allow time for the parents to give the physician feedback and thanks.
Give a certificate of accomplishment to the child.
Be aware that families are relieved but fearful of the future.
Our last day of treatment was horrible. The fellow was angry at me because I had arranged to have my daughter sedated. The fellow was signing the necessary forms muttering over and over, "This is ridiculous." When I asked her what was bothering her, she said that she was going on a business trip, which I was delaying, and her son had chicken pox and she was worried about it. She said another doctor was going to do the procedures because she was in a hurry. When I asked if I should wait for the results of the bone marrow, she said, "End-of-treatment bone marrows are at the bottom of the pathologist's priority list, emergencies come first, he'll get to it when he can, and the report won't be written for days." I thought that she was being heartless, but I didn't want to fight in front of my daughter. So I went across the hall and asked the director of the clinic if she would please call me that afternoon with the results of the bone marrow. She replied, "Absolutely." She called, told me it was clear, and we felt jubilant and relieved.
The nurses at our clinic really made a big deal on the last day of treatment. They brought out a cake and balloons, and sang "Going off Chemo" to the tune of "Happy Birthday to You." They made Gina a banner and bought her a present. I sat in a corner and cried, because I was scared to death of the future. A nurse came over, hugged me, and said, "This must be so hard, we're taking away your security blanket." She was exactly right.
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