Joel the baby knight was being chased by a dragon that only the bravest knights can go toe-to-toe with, a dragon named cancer. Armed with some basic armor and a spear, Joel-the-knight would jump over yawning gaps, crouch to avoid the dragon's flames, and throw his spear at red crabs. God's Grace would help him where he thought he had yet to stop, though being granted this superpower didn't necessarily mean living on, either. —Spectators rather than players we are to guide the little knight through the above 2D-platforming section, but whether doing it good or bad, we cannot win the play for him: there is no curative treatment for Joel's terminal illness, the brain cancer he was diagnosed with when turning one, and we won't get any achievements from it.
No win-loss condition lets us decide about the hero's life or death in That Dragon, Cancer like in a "normal" video game, but video games aren't normally based on real facts, either. We will be playing various minigames like the one which coined its name on this spiritized and often poetic journey that lets us accompany the Greens in the 14 separate scenes depicting their grief and solace, but mostly we just interact with objects and environments in a common point-and-click like manner. Eye, hand, footstep symbols show us where to go and what interaction to expect as to the surrounding objects, for which right and left sticks plus just one button are usually sufficient.
Small kids approach their environment in a playful manner, even if they are sick like Joel, so playing with him and making him laugh in his long on and rare off-hospital days is also how we experience his illness: as a game. We maneuver the duck that picks up the bread crumbs Joel does throw us, we push him on the swing and sit with him on the slide, we blow him soap bubbles and drive his go-kart in a crazy race—just ultimately, we can do nothing to make him feel better when he won't stop crying with pain. For interactive is just the gameplay—we even get to play as a gull in Adrift—and not the narrative itself, and so no waypoint “choices” are giving the player the control over the progress of the story.
There are no “collectibles” in That Dragon, Cancer, but the hospital walls let us look at former patients' defiant drawings and read their relatives' many color postcards, while the kart race through its corridors does win us a collection of Joel's clinical supplies: Blood Transfusions, Radiation Treatments, Lumber Punctures, MRI Scans, Hydrocortisone, Dexrazoxane, Cytrabine, Imidezole...—a game does not necessarily have to be fun.
This is particularly true for the "lucky wheel" game pivot of the bad prognosis in scene 7, "Sorry guys, it's not good": the Greens and the two doctors get both their turn to express their thoughts, but all know that from now on, things won't get any better. It is likely their tears that rain-like soon form an ocean with Joel (and Amy) floating in a small boat, while Ryan is drowning: "Why am I not yelling?".
Tragedy in video games is rarely real; more than serial novels or movies where the hero never dies, video games create the illusion of immortality: even in case the player is forced to restart from scratch after an old-fashioned "game over" or has to wait spectating the others until the end of the round—there is always a "once more" possible. In real life, there is not; as the simplified arcade machine in scene 11, Dehydration, shows, "Continue" is not an option as far as Joel is concerned, and pressing any button won't help make him stop crying until we hear him bang his head against the cradle.
Of course we know from the begin that Joel is eventually going to die (a “spoiler” in gaming terms); the Greens, at the time related in the game, don't. Of the two, Ryan is the one that expresses more doubt than confidence; where Amy firmly believes that Joel will be healed—"my doubt is insignificant compared to God's faithfulness"—Ryan says that he hopes but doesn't know. He's not expecting much from anything and certainly no supernatural miracles as "presents from the Lord"; still, he envies his wife for her faith, while he feels himself drowning. We, the silent spectators, understand both: we have only so much hope we can handle.
In scene 3, On Hospital Time, Ryan has a nightmarish dream turned into a minigame: Joel flies suspended on eight cell-shaped balloons in a nocturnal sky with thorny cancerous clouds we try to circumnavigate until in the end all balloons are popped and Joel falls down. In another vision, mid-game after the doctors' pivotal prognosis (scene 7), Ryan sees himself drowning in the ocean and aimlessly diving underwater among spiny cancer cells. With the symbolic image of Joel in a small boat drifting on the ocean he recalls the story of the stormy Sea of Galilee: Jesus' disciples are worried about Him letting them drown while asleep in the back of the boat. The drowning Ryan is overcome by reality and he feels, Amy's boat is missing the oars: "you don't even know where you're going, and yet you are sure to arrive". The symbolic Lighthouse—life as light in the darkness—alias The Temple of God, is where the boat arrives after crossing the ocean, which is also an ending, though not how That Dragon, Cancer ends: a happy Joel, with Manju, pancakes, and soap bubbles.
We can find quite a lot of symbolism in That Dragon, Cancer: the armchair where Ryan rocks Joel in On Hospital Time (scene 3) is green, while the one in scene 11 is blue; nasty cancer cells as well as (burnt) trees are black, whereas the Temple at the end of the game's journey (scene 13) is purple, red, and blue (and green Joel's altar-like chair). Yet in Dehydration, Ryan reflects also about the "colors that heal" like those chosen for the hospital: green for life (their surname), blue for comfort (the ocean), and "purple stripes to hide the stains". Thusly, the symbolic meaning that the images in That Dragon, Cancer convey are also a way to express the Greens' spirituality; in the end, will their love and fear matter enough to be turned into mercy? "Will Jesus even care?"
Both grief and spirituality are something very intimate, sentiments the Greens chose to turn into a game-like experience, rich in images, poetry, music, and thought: Cancer as told to children. While some players might have difficulties with the authentic story background of That Dragon, Cancer, albeit rendered with simple graphics and figures fillable with our own imagination, it delivers many in-depth moments one wouldn't want to have missed.
When Joel dies, after four years instead of the prognosed four months of palliative care, his parents feel both empty and full: while Joel's laughter ceased, as well as his cries, their hearts are still full making them glad they "loved him well". The four years of reprieve can be seen as a “small victory” over death which allowed the Greens and their other healthy kids to learn to know little Joel and the things he loves, and which they would choose to replay, if only the possibility would exist.
With (virtual) death being both nonexistent and omnipresent, the mere idea of turning a process of grieving into a game-like experience makes one also reflect about the impact of video games on the way we perceive reality. So Joel gives the brave dragon-fighting knight and Ryan the "compassionate, caring father" in what, for moments, may even be sort of a shared “adventure” they'll be looking back to in a couple of years. But even with Ryan Green as one of the game's coders it is obvious that That Dragon, Cancer is above all a form of sublimation encoded in colorful images, melancholic music, and poetic phrases. Music and sound design (Jon Hillman) plus the excellent voice overs mainly by Ryan but also Amy Green (voice mail, letters), among others, is the adhesive that brings That Dragon, Cancer's heterogeneous elements together without—like in the purplish Temple of God where interacting with organ keys and candles does reproduce instrument sounds, voices, whispers—wanting to be ever “definitive”.
Alas, That Dragon, Cancer is no interactive adventure that permits us to choose the outcome we prefer; more serious than really sad it is however a thoughtful episodic journey we are thankful to get to experience.