Science and Technology news - That Dragon, Cancer: is it right to make a game about cancer?

A scene from That Dragon, Cancer.
When Joel Green was diagnosed with terminal brain cancer, his parents took an unusual step. They turned their family’s tragedy into an interactive computer adventure. A scene from That Dragon, Cancer.
The scene goes like this. Ryan and Amy Green are sitting in a hospital waiting room. Their toddler, Joel, slouches beside them, playing with a toy that makes farmyard noises. He is giggling cheerfully – but their world has just collapsed. A year ago, Joel was diagnosed with an atypical teratoid rhabdoid tumour, a particularly invasive form of brain cancer. He was treated with radiation and chemotherapy, but now a doctor, fighting back his tears, is explaining that the tumour has returned. Little Joel will not survive. It is just a matter of time.
A downpour starts and the room slowly fills with water as lightning flashes in great, blinding streaks. Finally, only Joel remains above the swell – in a small rowing boat, the room having become a violent ocean. There is no way he can survive.
Such a scene would be harrowing in a book or a film, but that is not how anyone will experience it. This is a scene from a computer game.
For the last three years, Ryan, a game designer, has been working with a team of coders and artists on That Dragon, Cancer, a kind of interactive biopic, exploring his son’s life and the experience of caring for him. The game takes the form of a “point and click” adventure, like the PC favourite Myst, built around his family’s memories. It began with a book Amy wrote to explain Joel’s situation to the couple’s four young sons. In it, she depicts his struggle as a mythical battle, with his cancer portrayed as a terrifying dragon. Ryan instinctively saw the story’s possibilities as a game. “Amy and I are creative people, it’s just what we do,” he explains, in a video call from his home in Loveland, Colorado. “I knew I wanted to make a game called That Dragon, Cancer before I even knew what it was.”
One particular moment cemented his decision. In 2010, weakened by palliative chemotherapy, Joel was struck down with a stomach bug. He was taken to hospital and placed in an ICU room where Ryan spent a devastating night, sitting with his son, watching as he wailed in pain and frustration, banging his head against the bars of his cot. “That experience stuck with me as something that was highly mechanical and indicative of our whole experience,” he says. “You’re trying to find just the right lever to pull to make everything OK. Maybe if I could get him to drink some juice, I could stop him crying. Maybe if I could just do that, everything would be all right.”
Ryan channelled this determination to “win”, to beat this invasion, into the game. In one of the first sections he wrote, the players are put into a small, plain room. They see Joel in the cot and hear him crying, and they see objects they can interact with: a sink, a carton of juice, a window. They try different combinations, clicking on whatever they can to make the crying stop. But it doesn’t. And one thing you definitely can’t click on is the door handle. There is no escape.
It is traumatic. Having shown off That Dragon, Cancer at various games events over the last two years, Ryan and his team are used to players bursting into tears. But what is brilliant about it (beyond the simple visuals, which leave Joel’s face blank so that it can be mentally mapped with another face, perhaps that of your own child) is the way it subverts gaming expectations. It looks like an adventure game, a puzzle you have to solve, but as the scene plays out, you realise that, like Ryan, you are trapped here. There is no solution. At one point, the viewpoint – which had been showing the room as if through Ryan’s own eyes – moves outside the window and looks back in on the scene. Suddenly, you are separated from Ryan’s anguish by a pane of glass. It is a merciful release.
Ryan speaks about this moment with remarkable clarity – partly as a parent who has experienced this despair, but also as a game systems designer who can’t help thinking that way. “I see life as very gamelike,” he says. “Fighting cancer is like a game because you’re trying to do just enough to kill the cancer but not hurt the child. You balance all the options. And it’s a multiplayer game because you have doctors, nurses and family all involved in this process of trying to keep your child alive. There are puzzles, as well as simple mechanical tasks like administering medication, taking blood pressure, giving him food – or making him laugh. The difference is that, in a game, if you’ve mastered the skillset, you can beat the level. For me, that’s where the comparison stops.”
Ryan and Amy Green with their family.Mixed into the experience is a meditation on religion and grace. Ryan, his family and co-designer Josh Larson have a strong Christian faith, which they have leaned on heavily. There is a moment in the ICU scene where players get to click on a simple icon: “Pray.” Once again, Ryan sees gamelike qualities in the concept of divine grace. “If you think of Super Mario Bros, there are certain obstacles you can only get over if you’re given a mushroom to grow big, or a fireball to shoot. Those power-ups are elements of grace the designer put in the game just for you, just in the right place, so you could get through. That’s a reflection of faith.”
But he is keen to point out that the game isn’t an attempt to convert non-believers – it’s simply a medium that provides an interesting way to explore a key element of his family’s experience. “Faith isn’t something that me and Amy add on to life,” he says. “It’s intrinsic to how we see the world, what we do for Joel, how we raise our children. It’s not meant to be preachy – it’s to show you what it’s like and what we’ve experienced.”
The game is, however, more than just a succession of emotionally gruelling scenes. There are reflective moments and humour, too. In one sequence, the Greens are at a pond feeding ducks when Joel throws in a whole loaf, much to the amusement of his brothers. Although we only see Joel on screen here, the soundtrack is a recording of Ryan and Amy discussing the memory with their sons. It is deeply touching. Other scenes are dreamlike and surreal, accompanied by short snippets of poetry. The cancer is often shown figuratively: sometimes as throbbing black skeletal trees in an otherwise beautiful woodland scene, or as the swooping shadow of a dragon. “I want this game to have a rollercoaster of emotions,” says Ryan. “I want it to have funny moments, sad moments, desperate moments because that’s the whole experience. That’s what it was like for us.”What the game format also allows is a sense of shared, almost communal experience. During development, Ryan and his team talked to doctors, family and friends, to Joel’s teachers, and they have sought to give players direct experience of all these viewpoints. “There will be moments when you can be in people’s heads or outside the situation, looking at the conversation as a fly on the wall,” he says. “That can be a freeform thing, something the player chooses to explore. For me, that’s one of the strengths of a video game universe over what a film can do: you have the choice of going in and out of people’s heads and discovering a story in your own way.”
The team has also found that the game has become a release for some players – a means of exploring and then discussing their own experiences with cancer. It can be hard for a teenager to find comfortable forums to discuss fear and grief, but games facilitate agency in a unique way and they come with their own communities. “I think you’ll find that people play it with their spouses, with their children, experiencing it together,” says Ryan. “That’s important. That’s how you win the game in our eyes – by having a deep conversation with someone afterwards, by being able to talk about these important things.”
That Dragon, Cancer takes the form of a classic “point and click” ­adventure.
On 14 March last year, Ryan posted a short message to the That Dragon, Cancer blog: “Joel took his last breath at 1.52am.” He died after fighting a succession of tumours over four years, after relearning to walk and speak several times. No one ever gave up. Work on the game paused for a little while. The team attended the funeral, then coding started again. In November, Ryan launched an appeal on Kickstarter and raised more than $100,000 to continue development. He and Amy have invested everything they own in the game – they have to keep going.
People have asked: “Is it right to make a game about cancer?” But games are an expressive medium, just like books and films, and for a new digital generation, they are increasingly the way that life is processed and understood. Game-makers at major studios are growing older and thinking about new things, meaning that narratives are maturing. “We’ll have less games about saving the world and more about saving your child,” says Ryan.
At the same time, the rise of the internet and the availability of intuitive game-creation tools, such as Game Maker and Twine, have allowed anyone with a bit of time to create thoughtful idiosyncratic experiences and put them online for a global audience. There have been games about depression, such as Zoe Quinn’s Depression Quest and Will O’Neill’s Actual Sunlight; about transgender issues, including Anna Anthropy’s Dys4ia; there is also Nicky Case’s self-explanatory Coming out Simulator 2014.
“There is something in this industry that’s pointing toward experiential games,” says Ryan’s sister Stephanie, who helped demo That Dragon, Cancer at the Rezzed festival in Birmingham last year. “Games can show us real-life experiences – raw, beautiful and moving experiences that take people in a different direction. For Ryan, it’s an artistic expression, too, that whole idea of games as art and what that means. I’ve been in that hospital room. I knew what it was like, but not from his perspective. That’s what’s interesting about the game: it gives you a glimpse of what it’s like to be him, the father. It’s not a game about escape, you can’t press a button to make it all disappear. It makes you confront the reality of it. This is a whole new movement for the industry. There will be more games like this.”
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