Seaside 4-year-old comes out of a long battle cancer-free and ready to play.

The late-morning sun leaks in through the living room window, painting the couch with warm brushstrokes. Between parents Alex Pfefferkuch and Sarah Van Der Stad, 4-year-old Madeline “Maddie” is sprawled out under a blanket of American Girl dolls – some with hair, some bald – and several doll outfits and miniature accessories. Maddie’s a tad tall for her age, and her tousled hair matches her rootbeer-brown eyes. She doesn’t seem to notice the gastronomy tube secured to her nose.

No one has to say a word, but the air is light with relief: Last night, July 7, the family returned to their Seaside home after what they hope was their final extended hospital stay for a while. Maddie has completed all the scheduled inpatient treatments since her May 2013 diagnosis of Stage-4 neuroblastoma, a cancer that begins in immature nerve cells and aggressively spreads to other parts of the body.

This past May, exactly a year after the diagnosis, doctors concluded there was “no evidence of disease.” Maddie will undergo three final treatments at home, and hopefully, follow-up scans will remain clear.

As for Alex, a special-needs teacher with the Monterey Peninsula Unified School District, and Sarah, director of MY Museum, life as they knew it will never be the same.

Over the past year, they’ve spent more than 160 days at Lucile Packard Children’s Hospital at Stanford University, as their daughter braved chemotherapy, surgery, stem-cell transplants, radiation and immunotherapy.

“It’s like getting thrown into this horrible rabbit hole,” Sarah says. “There’s a sense of hopelessness. I couldn’t accept that it was even happening. I’d go to sleep, then have to remember everything again when I woke up.”

Alex was more proactive, vigorously surfing the Internet. “There are still pretty dark statistics for this particular disease, because a lot of treatments are still in the clinical phase,” he says. “A lot of the research hasn’t been updated.”

Enduring constant rounds of chemo and radiation and other draining treatments became a new normal for the family.

“Sometimes we’d be cruising along, getting treatments, and think of something that reminded us of life before. It would really throw us into despair from time to time,” Sarah says. “The best thing to do was to accept that it’s not going to be easy and never give up.”

“A princess with boots,” Maddie announces as she holds up her freshly-booted doll.

“Yes, a princess with boots,” Sarah says.

“[Maddie] is the most inspirational of all, because kids don’t know any better than to get better,” Alex says. “She just kept getting healthy after every treatment. She wanted to get back to daycare and play.”

The family isn’t expecting to reach a level of normalcy in their lives any time soon. Maddie must continue to use the gastronomy tube. All the treatments and amino therapies have built up in her system, leaving her in a perpetual state of nausea and making it hard for her to keep down solid food. (She prefers McDonald’s Happy Meals when her stomach allows it.) The tube also helps Maddie stay hydrated, which is even more important, since she has only one kidney. Her left kidney was removed in a 10-hour surgery after a tumor engulfed it along with some neighboring blood vessels.

Caring for a chronically ill child takes its toll on even the strongest marriage, but Sarah and Alex believe theirs is even stronger.

“We knew this year was going to be just about Maddie. Everything else gets pushed to the side,” Sarah says. “Now that we’re in this home stretch, we’re starting to have conversations about how to get our own lives, outside Maddie, back on track.”

Medical bills and other expenses are another unavoidable reality when dealing with a life-threatening disease. Sarah and Alex, who maxed out their private insurance deductible within 24 hours of Maddie’s diagnosis, seem to be making it out in one piece. Though Alex took a leave of absence from work and Sarah cut her hours, they’ve managed, thanks to a whirlwind of unsolicited support. A 2013 benefit at Carbone’s and Maddie’s Monsters, an online donation page, have raised several thousand for the family. Alex and Sarah also credit the hospital billing staff for making Maddie’s conversion to Obamacare painless.

“There’s a whole team at Lucile Packard who deal with your insurance so you don’t have to,” Sarah says. “They always push the treatment forward because they’re all about kids and cancer research.”

In August, Maddie turns 5. When asked what she wants to do for her birthday, she responds with a slightly annoyed, “I don’t know,” as if we should know her wish has already come true.

Donate to the family by visiting www.facebook.com/MaddiesMonsters