Mindfulness in gaming series 2: That Dragon, Cancer

How do you make a mindful game out of saying goodbye to your child with a terminal illness?

Continuing our series, I’m shifting gears away from myself and my own reality to examine another familys’ struggle. Before my first craniotomy to remove my metastatic melanoma brain tumor, a friend told me something odd but honest “John, the good thing is, is that this is happening to you.” It may seem like something odd for a dear friend to say to another going through brain surgery and cancer but he was right– his point was that it was not happening to either of my children– Will or Mina. But what if it had? There is an “game or experience or whatever-you’d-like-to-call-it” out there that showcases what happens when a child goes through a terminal illness: cancer. The name of that game is That Dragon, Cancer. And I’ll be discussing the game, the game’s subject, Joel Green, and the follow-up showcase documentary: Thank you for Playing, which gives in inside look into the Green family’s struggles and Ryan Green’s families’ and teams’ role in the production of the game while managing his child’s terminal illness.
This is a heavy subject and will be a heavy post. If you’re in vulnerable location, it might be best to read this post later.

That Dragon, Cancer uses an art style which allows you to fill in the details of the scene– it’s extremely effective. We never see Joel’s fully detailed face or features but our minds fill in the gaps and we know exactly what we’re looking at– it’s the same for the adults as well. The audio is real from recordings, through (except for the crying sounds– those are not Joel’s cries, at least that’s stated in the “Thank you for Playing” feature from Ryan Green (father, creator, and developer). The game consists of a series of scenes you can choose to go to and experience at anytime from the main menu (similar to a DVD or bluray disc). The first scene is “Bread on the water” followed by and “Park at the edge of the world” and starts with a sweeping view of a beautiful park on a pond, the music swells and feels very natural and calming as the view goes around the tall trees and the duck pond. We find the Green family playing at the playground and feeding some ducks in the pond. Joel throws an entire loaf of bread to a duck, leading his brothers to question why he would do that since everyone had been throwing tiny edible pieces. Joel’s parents explain to his brothers that he’s been sick since he’s been a year old and he’s just a little slower than the other kids– but it’s okay. It seems to pacify the brothers’ inquires. You end up walking around the park, the scene / camera following you and guiding you a bit. You push Joel on the swing and spring pony ride– all feels well and peaceful. It’s feels like an amazing spring day at a warm spring park in an ideal forest area. You find a picnic table and there’s a cell phone with an unplayed message on it. You play it and hear from Amy (mother, wife) that the doctor thinks that Joel’s nausea might be caused by some allergies or more food issues– more tests are needed. The tone is casual and unworried.

As you travel through the park the scene quickly changes to Joel strapped to a hospital gurney with spiked black tumor cells in the background. That Dragon, Cancer chooses to tell its story with images and scenes rather than a straight narrative. It’s extremely effective and even though you don’t know the exact details the tone of each scene lets you know what’s going on and it helps steer your feelings. In the feature “Thank you for Playing” they do give more details. Joel developed a brain tumor at a year old.

The next scene is titled “On Hospital Time.” It continues to use imagery to tell the family’s story. In the feature “Thank you for Playing” you learn that Joel goes on chemotherapy and his brain tumor heals. Nevertheless, images like the one above are hard to take in. The artwork in this game nails the feel of what a cancer center feels and looks like– they are always clean, with crisp clear lines, new furniture, lots of windows for natural light, and carefully selected colors. There is some monologuing about it from Ryan Green in a specific scene and he’s exactly right. In the hospital scene Ryan wonders aloud:

“What is pain without a word for it?”
“What is hope without a word for it?”
“Who am I to him? Dah-Dah.”

In this scene you end up wondering around the cancer center a little bit and you find another voice mail from your wife, Amy. It’s about more doctor check-ups. Also sadness about missing an “end of treatment party.”

You get heartbreaking images like this one and you can image being tired, dirty, and exhausted yet not being able to take yourself away from your child who maybe suffering.

As you and Joel drift asleep you enter into a dream sequence. As you can see, the graphics the games uses are simple but still beautiful.

As you and Joel drift asleep you enter into a dream sequence. The dream shifts to an image of Joel held afloat by spiked tumor cell balloons. Slowly, each one starts to pop and you become nervous (even as the “player”). The last balloon pops and you hear someone gasp loudly.

You awake to find Joel playing with a therapy dog. He is laughing and having a good time throwing the ball to the dog and petting him or her. It is warming to hear Joel laugh.

The game prompts you to wander the hallways of the cancer center / childrens’ hospital.

You end up finding what I called the “chemo wagon” and playing a little racing mini-game with Joel in the wagon. You control the wagon and do three laps around a hospital wing.

At the end of the mini-game, this information appears which I assume are all of the procedures that Joel had to go through in order to get his first brain tumor to disappear.

After you complete your go-kart mini-game, it comes to a sudden crash and you’re in a dark room that looks like it’s been torn apart by a monster (exposed concrete and rebar, the windows are gone) You heard Ryan and Amy (mother and father) asking questions sharply and it becomes apparent no one is leaving the hospital as planned (“When can we see our doctor? Because the doctor that’s here and on-call and is only a resident.”) and the questioning of some of the doctors assumptions regarding Joel’s treatment and timing.

The next scene has you enter a huge auditorium like room and flip on a light switch. You see your son, Joel, asleep on a table while a low electrical hum pierces the room. It’s a radiation procedure– it’s has many names (cyberknife, steriotatic radiosurgery, gamma knife). I have been through this procedure. I think the title “Temple of Man” is a nod to our advancement in cancer treatment. We’ve come a long way but we’re far from a “temple” however nice, clean, and comfortable we make it look. It’s still just our best hope. There are no guarantees.

I am very familiar with these images. During this scene, lots of images flash on the screens (colors, animals, toys) but I captured a brain image since I know that the brain is what the machine is working on.

You get to enter a dream sequence which I assume is maybe what Joel is imagining while he’s asleep for the radiation treatment. It’s abstract and beautiful. You play with constellations, different animals pop up in star form and make Joel laugh, and you bounce around the sky like it’s a trampoline. The music throughout the game is incredible. It always fits.

In the next scene, Amy (mother) is rocking Joel and humming sweetly to him. To the wall on the right are painted hand-prints of patients at the center. Joel’s hand prints are showcased and Amy talks about how bored Joel will be when he’s older and his mom will talk all about the hand-prints and cards and all of the time the spent at the hospital.

At this point you get to wander around the hospital and look at all of the cards that are hanging in each room. There must be 100 or so. They are for various people that are going through treatment or that have already lost their battle to cancer. I took screenshots of a few of them. I read them all.

This one got me. I’ve always pictured creating some sort of world– fictional, digital, or model, with Mina and Will and letting that be a nice memory.

Another hard message to read.

This is a rough scene it looks like this is the oncologist they trust and he is telling them that nothing is working. The scene is entitled “I’m sorry guys, it’s not good.” And that’s how he begins his short speech which relays that Joel’s body has failed to responded to any of the chemotherapy, so it’s no longer an option. When asked about how long Joel has he responds with, “A few weeks to, maybe four months.” The other doctor in the room stopped me from wondering about any more questions when she chimes in to state, “We are very good at end of life care.” As soon as she says this the room turns dark and it begins to rain inside of the room.

Before the discussion begins you play a modified game of “See-n-Say” except instead of animals it has the mother, father, and both doctors on it. You pull the handle and you get to her some internal monologue from each person. It’s a very creative concept. While Ryan (father) is focused on balancing hospital life with the time left with his son, he’s also thinking through how his job and the rest of his family life will function through this unexpected turn of events.

When the news about “End of life care” is mentioned the room turns dark and stormy. Amy (mother) focuses on the doctors’ reactions which she sees emotion and believes is genuine. She also starts going through the 4 month calendar of possible events– Christmas, New Years’, Joel’s birthday, and possibly Valentines Day. That’s already a lot to prepare for before dropping the biggest bomb– she is pregnant and hasn’t told anyone. Her thoughts fear that people will think that the pregnancy is a “replacement baby” and that people might think she’ll love Joel less because of this new baby. Which, of course, could never be true– but our human emotions let us get carried wildly away.

As the room fills up with rain water from the storm, Joel is found in a row boat being battered around by the the room’s dark and stormy waves.

In the next scene we see Amy clinging to Joel in a sail boat. We are no longer in a hospital or care facility. We’re in the water near some sort of island with a home on it (maybe it was a place they stayed for a vacation at some point?) We return here later and it’s referred to but I never found out its exact history. Only that it’s a place “not where Joel is” eventually. But it’s “where they [mother and father] are.”

After “Adrift” we play another go to a scene that consists of a mini-game called “Joel the Baby Knight.” It begins as a story for Joel’s brothers to help explain what Joel is going through and how he is very brave. Ryan and Amy explain that Joel is a knight and he is fighting a very powerful dragon named Cancer and that the dragon is very large, powerful, and breathes lots of fire. You actually play as Joel for a little bit of super mario-like jumping to dodge the dragon’s fire. You can even shoot arrows at the dragon– but eventually you have to realize the point is to lose the game, not beat the dragon before moving on to the next scene “Drowning.”

The scene goes underwater to show Ryan and a video game cabinet surrounded by tumor cells.

During this scene you control the boat and click on bottles found in the water. They contain messages like this one. Of course, I am a blubbering wreck at this point.

Like the hospital cards, there are more letters inside more bottles. I don’t know if they’re real or written for the game– it didn’t matter to me.

The next scene is called “Dehydration” at this has to have been the most difficult moment for me to play out. We are back at the hospital / cancer center and Joel is in bed but will not sleep because he is thirsty. As a character (Ryan– dad) the only thing you can do is pace around the room and listen to him cry. It’s heartbreaking. Every parent knows this situation, even if its not in the midst of taking care of a terminally ill child. Eventually Joel becomes so frustrated he begins banging his head against the crib– horrifying Ryan and getting him to plea with Joel with all of the emotion and sympathy he can muster (of course this got to me). After knocking juice boxes away, eventually Joel drinks one and as we pace (the only place you can walk to is the bathroom), you eventually hear Joel go to sleep. You feel temporary relief.

Ryan reflects on his first days in the cancer center when he considered himself the “hero dad” in his own narrative. We then back to the sea and the island in a scene named “Peace, be Still” Joel is sitting on the dock of the vacation home and Ryan is wading in the water some distance away from him. Ryan reflects on some religious passages about storms, Christ, waiting, and staying calm.

The next scene takes place in a church. As you can see, the game sticks with poetic, abstract, and beautiful imagery.

You walk closer into the church and can see Joel on the nave and on the screens above the organ pipes. You approach a table with candles to light for prayer. As you light one candle, another goes out. When you light a candle you hear people sitting in the church pews praying for Joel. As you light each candle the prayers seem to become more insistent and urgent– “God you can do this, you can heal Joel.” But you can never get all of the candles to light up at the same time. Joel sits quietly as he’s prayed over. After a few minutes with the candles the camera pulls back and we’re taken to to the last scene “Picnic at the edge of the world.”

If you turn the mouse around you see a giant spiked tumor cell blocking the exit of the church. It’s a bit scary actually.

The next scene, for Picnic at the edge of the world, shows Joel sitting at the front of a small row boat, and he points to a park he sees in the distance. As the boat starts moving to the park, we focus on a letter found on a seat. It’s from Ryan to Amy– it’s heartfelt, moving, and beautiful.

Your boat gets to the park and it’s the same park from the start of the game– grand sweeping trees. A boardwalk path takes you to a picnic where Joel is sitting. He is happy to see you and “Glad you made it too.” He invites you to look at the incredible pancakes which are as large as he is.

He loves the pancakes and can have as much syrup as he wants now, which makes him so happy. He even has a dog, and he’s always wanted a dog. He’s named the dog “Manju” and even Manju can have pancakes with syrup.

Joel invites you to his pancake picnic and gets ready to toss a pancake to Manju.

Joel dips a pancake in syrup, and tosses it to Manju who catches it from the air and eats it. “I can eat whenever I want, and I’m never full.” Joel says as the game ends.

Thank You for Playing— This is a 1 hour 20 minute documentary by Kinematic films) about the creation of this game. We learn more details about Joel’s condition, treatments, and the process of creating the game, its reception, and we’re forced to think about what a game actually is.

The documentary beings with showing Ryan Green (Joel’s father) working on the game’s 3d graphics while his kids watch him work.

It then shows Joel’s brothers pulling him around the cancer center on the “chemo wagon.”

We learn that at Joel was given 4 months to live at age 1, but he remained stable for 3 years.

In a discussion scene Ryan says, “I wanted to create a space to talk about my son and for other people to love him and have the joy I have being his father.”

There’s a discussion shown between him and his wife Amy and as I mentioned earlier audio of Joel’s cry is not in the game but his audio of real laugh is.

Ryan talks about his journey going to college, what he hoped to do for a living, some aspirations and dreams of making a big artistic statement, starting a family, managing that and then saying, “wasn’t til the last 4 years I had something to say.” I am familiar with that sentiment.

Another statement: “I feel pretty heavy right emotionally, because when you’re creating art– there’s an certain level of abstraction, it’s not real and so even in the midst of working on a game about my son who is terminally ill there’s a certain escape that’s what’s kind of ironic about it, right? Because a lot of times people play games to escape. And even making a game allows me to escape but you can’t escape forever.” [he shrugs]

A graphic appears and we learn that Joel’s tumor comes back and he starts 10 days of radiation treatment. (similar to my cyberknife procedure, I only had 1 treatment but it’s what caused the necrosis I’m currently going through).

The documentary shows Ryan’s team collaborating on the game with him over video calls.

One Quality Assurance tester said he would turn off Ryan’s audio for quality checks (because of the intense emotion) but he had to turn it back on because eventually the game became very odd without it.

Ryan reflects, “I think that allows us to come face-to-face with the fear of death and kind of move past it and it’s kind of something that I want to articulate. I want to bring players face-to-face with that shadow of death and ask them what they really believe.”

Another scene shows Ryan breaking down in tears while recording his portion of intense audio for the game.

The documentary next shows Ryan showcasing his game at a video game conference called PAX (Penny Arcade Expo). The video game conference is full of high dollar video game companies showing off the latest sports games, first-person shooters, sci-fi, fantasy, indie and any sort of flashy, fast form of entertainment you can think of. And Ryan is setting up his booth to show off his game about cancer. There are some takers that sit down play the game– at least one person finishes it and discusses it with Ryan– there is a profound feeling that can be sensed. There is footage of people sitting down to play it, becoming bewildered but still fascinated. I mean, you’re at a convention about entertainment and then you’re sitting down to play a game about someone’s son dying. At this point in Joel’s journey we don’t know what will happen to him and Ryan does say that to the people he talks to– even thought the game is complete (or at least will be). In an aside Ryan says, “It’s kind of weird to say but fighting cancer is kind of a game it’s like a game in our life we’re trying to find the right formula to save our life and my son’s life and that’s a mechanic and so when you start seeing the world through what are mechanics and what happens when mechanics fail I think you can see the potential that games can be.”

Later we see Ryan speaking at a panel. Panel conversations are very common for these types of conventions but to have such a serious panelist is rare (at least I think it would be). “In a hospital there are 500 other rooms with doors closed. Why is it so strange to talk about it?”

In another transition we learn that Joel’s family is going to San Francisco for a clinical trial because Joel has developed more tumors.

“I think it’s easier to retell pain, it’s harder to concede joy. I gotta figure that out still.” Ryan reflects.

The doctor’s give Joel’s chances of a successful trial at 10% or working.

After more tumors appear, the family returns home for hospice care.

A hospice care worker shows the Green family how to regulate some sort of IV machine. Offers 24 hr / 7 days a week availability and then leaves.

We see the house full of friends playing and singing church guitar songs.

The screen fades and reports that Joel dies at 1:52am that night.

“I’m so scared I’m going to forget Joel,” Ryan breaks down.

We zoom to 3 months later and we see the siblings playing with new baby Zoe.

Ryan reflects, “I think that’s the mystery of all of this. That life isn’t built on how well things have gone. It’s the whole crazy mess of it.”

“The most fulfilling and meaningful and compassionate moments of your life can be in the middle of the deepest loss you experience. I think that can be beautiful. I hope it’s beautiful.”

To me, Joel lived his life in the moment. I played this game over two days. The second day I was full of sadness because I realized I was saying goodbye to Joel. I still get overcome when I think about the experience of playing this game and watching the documentary. But I’m still very glad I did, I’m glad to be writing about it even though it’s hard and I’ve had to take several breaks. I think this is showing the boundaries that games and different media can push and need to keep pushing. We need more games like this to help us cope with this very real pain and suffering and keep us mindful. That Dragon, Cancer is available for purchase on Steam, Windows, iOS, and Android. Thank you for Playing can be purchased on steam, purchased or rented at http://www.thankyouforplayingfilm.com/. I highly recommend both.