Making a game while recovering from cancer

Before the diagnosis hit, I was working with my brother Seth at our tiny game studio, Butterscotch Shenanigans. We had been in business for 11 months and released two games. The first game failed financially despite rave reviews, but the second managed to bring in just enough revenue to show that our dream of making games would work. We were figuring out the mobile industry and beginning to make a name for ourselves. But then, BLAM, the Gods of Chance reached down with their grubby middle fingers and ground everything to a halt. Over the course of three months I lost 20 pounds and became increasingly tired and aggravated. At the end I was drinking two pots of coffee before 9 a.m. just so I could work for more than three hours. Something had gone desperately wrong.

And so I went through a flurry of tests. Medical professionals expressed bafflement that I was still standing, as their initial tests showed I was as much cancer as I was human. The entirety of my insides glowed with a sickening white light on the PET scan. I was filled with cancer. They whispered in hushed tones that I should already be dead, or would be within a few weeks — if I didn’t start treatment immediately.

Ten days later, after getting the first round of treatment underway, Seth and I sat down to discuss the game we were working on: an endless runner called Extreme Slothcycling. We had already made progress in development, and the game was already fun. But somehow that wasn’t enough. I couldn’t see myself working on this silly little game through the months of treatment and uncertainty that were to come.

And so I wondered, what if we did something deeper? Could we build a game that I could slip into during treatments, a game that would let me forget about being sick from chemo or nervous about upcoming test results? Could we build a world designed precisely to remove me from the painful reality of what I was about to go through?

I booted up Game Maker and started prototyping, trying to make something that would convey what I thought I needed. I ended up with a Roomba-like creature that drove around picking up leaves, eventually fashioning them into a pair of sandals that it could wear as it roamed about. The sandals were useless, the game hideous, and it took no more than 10 seconds to experience all it had to offer.

It was terrible.

Seth arrived the next morning, ready to work on Slothcycling, and I instead assaulted him with my sandal-clad Roomba. I told him that I didn’t want an endless runner to be the last thing I made before I died. I wanted to make something that mattered. And what mattered was this hideous Roomba and its sandals.

Whether out of exasperation, brotherly love, vision sharing or just not wanting to shut down the wishes of a cancer patient, he agreed. We would try to build that world that would let me forget about mortality and my shiny-headed baldness, and doing that would be our way of fighting through the bullshit together. And once everything was over we could share our built world with others looking for an escape.

We put Slothcycling on indefinite hold and started work on the game immediately. It was to be an outlandish, story-driven adventure crafting RPG called Crashlands, and it would take us both through my cancer treatment and serve as a big "FUCK YOU!" right to cancer’s stupid face. I worked on it feverishly, no matter what: in the hospital, at home under the weight of spine-crunching bone pain and between waves of nausea. Whenever I had space for my laptop and mouse, I wanted to work. And I did.

Cancer, the great clarifier

As bleak as the future sometimes seemed, in many ways my cancer was a great clarifier. For Seth and me it meant ditching our chronic short-terms goal of rapidly publishing small games to instead work on something huge, challenging and, hopefully, deeply meaningful to us and to its future players.

For my other brother, Adam, who was wrapping up a Molecular Biology Ph.D. at the time, it meant completely re-evaluating his life trajectory. Instead of continuing along a path that seemed the inevitable result of a lifetime of studying science, Adam decided that making games with his brothers would be more fulfilling. When he successfully defended his dissertation we celebrated by handing him his Butterscotch business cards. And so he joined the team as our tools and web programmer.

So it goes

When we started Crashlands we thought that six months later I’d be done with cancer treatments and the game would be finished. Come March and the end of my treatments, it seemed that I had beaten the cancer already, and the game was still far from complete!

Seven months of cancer-free goodness later and everything was really looking up. We started building hype for the game, anticipating a late Spring 2015 launch — it seemed that after brawling with cancer for a year and having my entire life derailed, things were right back on track.

Then, a few days after Christmas 2014, I found a lump on my left chest wall. Again.

I wiggled it around, squeezed it, hoping maybe it was just an inflamed node, filled with a virus or, really, anything that wasn’t cancer. But it felt rubbery. And it was too fucking big. I tried to finish showering but ended up crying. My fiancée heard and came into the bathroom. I told her the news, because I already knew what it was, and we both cried until the water went cold.

I knew that this time around, it was going to be worse. If you get re-diagnosed, you begin a far more aggressive form of chemotherapy called "salvage chemotherapy." It was going to make the first round look like a relaxing day at the spa.

Right around this time I was about to go on vacation at Disneyworld with my fiancée’s family. The trip had been planned months in advance, and I’d be damned if I was going to let a stupid rubbery chest lump get in the way of it. I put the lump out of my mind as best I could and wandered through that place of imagination for two days, enthralled by the scope and vision of the Disney empire. I enjoyed the hell out of myself, and somehow managed to return relaxed, inspired and ready to face the cancer once again.

On the return trip home I re-organized my production notes for Crashlands and sent emails to my doctors. They sent me back the treatment details: I was about to go through two stem-cell transplants, a boatload of chemo, and radiation. I knew the treatments would buy me time at least until the next December, even if everything failed. And we still had a lot of work to do to finish Crashlands.

Transplantation

In May, after three brutal rounds of chemotherapy, I went in for the first stem-cell transplant. The docs gave me a new chemotherapy regimen called BEAM, which is an appropriately intimidating acronym given that it amounted to six days of dystopian sci-fi torture.

The final drug of BEAM, Melphalan, is a cousin of mustard gas. It’s administered once, for just an hour, and requires that the patient continuously eats ice for an hour before, during and after (referred to as Cryotherapy). This is because Melphalan is so toxic that it kills the internal lining of your gastrointestinal tract from mouth to butt, leaving massive internal sores that make eating impossible and throwing up even more painful. Eating ice caused the capillaries in my mouth to constrict, making it less likely that the drug would make the inside of my mouth into one big, open sore. By keeping myself frosty the entire time, I could cool down even more of my digestive system, mitigating those horrible overall side effects.

I ate so much ice I gave my tongue frost burn, but managed to dodge the lava gut that typically accompanies Melphalan. I was unable to avoid the other effect of Melphalan, which is total destruction of all bone marrow in the body. You can’t eat enough ice for that one. Fortunately, this was all part of the plan. Prior to treatment I donated a good few million of my own bone marrow stem cells and had them frozen. So after the Melphalan destroyed my marrow, leaving me slowly dying and unable to even produce my own blood, I got a fresh batch of my own stem-cells to replace what was lost.

The transplant itself happened on day eight, after I’d been fully obliterated by BEAM. It was simultaneously one of the most important and most anticlimactic treatments I’ve ever received — they hung a bag that looked like orange Kool-Aid, which drained over three minutes into my body and made me smell like corn.

No fanfare, no lights, no Vlambeer camera shake, no epic sound effects — just the rich scent of corn for a few hours. If the moment had been designed by a game developer I like to think the hospital walls would’ve thrummed, a light would’ve flashed and something akin to Link’s item discovery theme would play with an on-screen text flash that said "+5,000,000 NEW CELLS!"

Instead, the effects of BEAM slowly rolled in. I fevered for the next week and threw up whenever I was required to stand for more than 60 seconds. I developed a coughing infection that withstood any drugs and made it feel like I was breaking my ribs with my own hacking. I felt, for a few days, like I was actually dead.

During that time Adam surprised me with a Vibe Wall he cobbled together to handle the stress — friends, strangers, fellow game devs and fans took to it and left 455 messages, cheering me on. I cried when I read it, and then pulled out my mouse. There were more than four square inches of space on my side tray table for that mouse so, when I could, even if just for a few minutes a day, I made more art for Crashlands.

At the end of four weeks I emerged from the hospital with no eyebrows, like I’d lit a firecracker too close to my face. But I got to go home, to escape the hospital’s smells and constant beeping which, I had learned a few days into my stay, were the occasional sounds of adjacent patients trying to die. I had a two month break before the second transplant that would complete my treatment. That meant two months to rebound, and to work.

In June we wrapped the trailer for the game and launched it onto Steam Greenlight. It went through in 42 hours with 70% YES votes. We were tremendously excited. After taking a few moments for celebratory cheering, we dug back in. Adam finished the tools needed to build story into the game, which meant the biggest thing between us and launch was filling the world of Crashlands — a place the size of the freakin’ Netherlands — with stories.

The final push

We looked at the work left on the table and found that, of the three of us, the story-writing was going to fall primarily in my lap. The art was nearly all complete, save for a few bosses, and we weren’t near launch just yet, which meant my second job — drumming up hype — was still in limbo. The three of us scoped out the major beats of the story, and then it was my task to use the tool Adam had built (the Crashlands Creator) to actually write it.

The two months of reprieve did not last long, and the second transplant came rushing up like a silverback gorilla we’d made too much eye contact with. Before I knew it I was back in the hospital for another four weeks.

This time, the transplant had different goals. The first one was designed to save my life from the murderous chemotherapy I was taking. This second transplant was going to be the final part of the cancer-attacking operation. The goal was now to obliterate my entire immune system and replace it with someone else’s. Permanently. As it turns out, the human body produces cancer cells on the regular, but our immune systems normally kill the rogue devils. For some reason, my own immune system dropped the ball and wasn’t perceiving my cancer as a threat. So it was time for a changing of the guard.

The treatment this time was also different — a combination of light radiation and a drug called ATG, which is actually manufactured in rabbits and is an anti-immune system cocktail. It’s designed to wipe out my immune system before the donor stem cells arrive, so that the two immune systems don’t start a battle to the death — a response called Graft vs Host Disease, or GVHD.

The fact that I didn’t have to get BEAMed again made this treatment feel like a walk through a delightful park. Nothing eventful happened — no massive vomits or bone cracking coughing fits, no four-day fevers or infection. The most eventful moment was the anticlimactic draining of the donor cells, which happened in much the same way as before, minus the scent of corn, as they were freshly flown in that morning from some lovely human being I’m not allowed to contact for two years. The nurse hung the bag, I asked my family to be silent while the cells dripped in, and we all watched for a few minutes while it drained.

A few minutes later we all cheered and the long slog of staying mentally sane in a 10x10 foot room for three more weeks began.

Luckily, I had tons of story to write for Crashlands and, blessedly, more than four square inches of desk space. So after my family left the hospital that day, I fired up my laptop and got to work.

Emergence

I exited the hospital in early September. Coming home didn’t mean treatments were complete — in fact, they still aren’t, not really. When you borrow someone else’s immune system things can get out of control really quickly, especially if it doesn’t particularly enjoy being borrowed. I have a 28-slot pillbox that covers just one week of meds, and I take around 20 pills daily. If I miss a dose my liver starts to take a beating from the borrowed immune system. I know this because it accidentally happened, and I had to add another suite of drugs to the pile to control the aftermath.

Crashlands’ story work continued well into November. The battle between my liver and the new immune system excluded, I dodged most of the major complications that occur in the first few months after a transplant — namely the strange viral and other infections that can strike a person when they have little to no immune system. I also grew back all my hair, which is one of the most powerful ways to feel less like a cancer patient.

We decided that hitting beta before Thanksgiving was going to be the best course of action — it would give our testers plenty of time to play the game over the holiday and let us tackle the initial bolus of crashes and other painful problems prior to taking a break with the rest of our family. We crunched, ecstatically, in the days leading up to it. On Sunday, November 22 at 7 p.m. CST, the Crashlands beta went live.

100 days by 100 days

Our testers instantly began devouring the game's content and sending feedback reports. By Tuesday night they had clocked over 22 days of playtime. By the next Sunday, just one week in, our 160 testers had played an impressive 100 cumulative days of Crashlands. Though we were exhausted, we couldn’t have been happier. All that playtime meant the game was doing what it was designed to do: transport players elsewhere, and infect them with joy.

As if the Gods of Chance were weaving some sort of strange poetry, when we hit the milestone of 100 days of playtime I also reached my 100th day of having a new immune system.

Day 100 is a day of reckoning. It includes a PET Scan and bone marrow biopsy, both of which are meant to take a look inside the body and read whether or not cancer is present. It’s a day of feedback that can validate two years of treatment, in the same way the Crashlands beta had begun to validate the two years of its development.

I'd been so preoccupied with the beta process and working like a maniac that I hadn't had time to think much about how momentous this was. The anxiety of walking into the hospital and maybe leaving with a re-diagnosis had been lost on me until the night before my appointment. But then the moment of truth was too close, and I couldn't sleep. I burnt the midnight oil fixing errors in the now 50,000+ word story of Crashlands.

The next morning, December 2, I went into the hospital with all my digits crossed. I checked my ribcage for lumps like the one I found in the shower when I relapsed last December, and didn't find a thing. I tallied the times I'd felt tired in the past few weeks to see if there was a pattern, as there had been when this all started. I thumbed the spot under my clavicle where, twice previously, a tumor had shown up. Nothing.

My fiancée accompanied me to the hospital, as did Dylan Kress, one of the filmmakers from Forever an Astronaut who heard about the story and has been covering it for a documentary series. He filmed as I got routine bloodwork done and then headed down to the PET scan room.

At the end of the PET scan the technician motioned for me to come take a look. I ran my eyes over the 3D cross-section of my body and saw nothing interesting. No bright spots. It was the most boring PET scan I’d seen. I asked the tech to run back through the scan of my chest area just to be sure. She slid the cursor around and as the cross-section worked its way from my neck to my pecs I kept waiting to see something. But there was nothing there.

Of course, I don't know what I'm looking at, so I tried not to get excited. I thanked the tech and hustled upstairs to wait for the doctor's official word. Seth and our mother met us there — we'd decided that Seth should hang back at home instead of coming to the hospital all day, so that he could fix more of the bugs from the beta. And then we waited.

Either way

Before Thanksgiving dinner a week earlier, my grandfather asked how I was doing and what was next for treatment. I explained to him that the scan, and potential re-diagnosis, was around the corner. He paused for a moment, then looked at me and said "Well, I suppose it doesn't matter either way, does it?"

And I knew that after two years of treatment, it honestly didn’t. If I walked out with another re-diagnosis it wouldn’t stop us. Crashlands was going to make it out the door — it was so close there was just no way anything could stop it. And, further, the cancer wouldn’t stop me. Despite all the time I’d lost to sickness, treatment and treatment-induced sickness, I had managed to be extremely productive: I’d spent more time with friends and family, focused on my work in an astonishingly cathartic way, gotten closer to my brothers, gained a fiancée and grown into a more powerful 2-D game artist in the process. And I’d done a ridiculous portion of this work from a hospital bed or while reeling from chemotherapy side effects, with just a mouse and a few square inches of workable space.

I have lived my life more fully in the past two years than I ever thought I could, and all of it due to getting cancer — to having my own mortality shoved in my face — and responding by fashioning all the bone pain, chemo nausea, anxiety, depression, stab wounds, tape rips and hair loss into an object designed to impart pure joy.

It no longer mattered if the cancer came back.

The doctor entered the room and after some brief pleasantries she paused and said "Now, I haven't gotten the word from the radiologist himself yet, but I read a lot of these, and ... I'm comfortable saying you're in COMPLETE REMISSION!"

My eyes stung briefly as I offered an awkward and long howl to the pantheon of scientists and deities that got us here. It was done. I was clear.

I am clear. cancer-free. In remission. It was the first time in two years that nothing, absolutely nothing, had shown up on my PET scan.

The rest of the day was a blur. The combination of not sleeping much from working on the beta, the extreme relief of getting a clear PET scan and lingering sedation from a very painful bone marrow biopsy put me in an otherworldly place. We went out to eat at our favorite BBQ joint. I stuffed my face with brisket and my belly with whiskey.

The next morning I woke up and sat down with Seth and Adam. We poured over the feedback from the past few days and compiled it into several lists, and found a few positive notes our testers had left behind.

From one, who is currently undergoing chemotherapy:

"... Even lying face first, wanting to constantly empty the contents of my stomach, all I really wanted to keep doing was keep playing."

From another, who suffers from PTSD related to combat:

"I've been searching for a game that makes me feel the wonder of childhood, that sense of innocence, that pure experience that only games seem to be able to provide ... From the start of the game all the way to where i am in the story 51 hours later, it has been pure joy ... It feels like being a kid again!"

Crashlands does what it was designed to do — to be a suit of armor, a retreat from a world that can often be too harsh and cruel. All the life that we poured into this creation over the past two years is about to come bursting out, and a world of players will soon be able to escape into it.

It works. And most people who play it will never know the story behind it, the reason why it’s so forcefully jubilant, riddled with snort-inducing humor, designed to pull the world away for a few days of time. And that’s OK, because it does the work it’s designed to do. And that has always been the point.

24 hours after I got declared "cancer-free" we set Crashlands’ launch date.

January 21st, 2016. It's happening, and nothing can stop it.

Thank you, to everyone who has given us a thought, a high-five, a vibe, a meal, a kind note or a platform to tell this story in the past two years. I can’t wait to share this with you.

Oh, and cancer? Go fuck yourself.

If you want to reach out, please do so — send us a note on Twitter @bscotchshenani, or send a direct email (sam@butterscotch-shenanigans.com).