University of Southern California Dissertations and Theses

Traversing the Green ward

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Traversing the Green ward

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Content 1

The Green Ward
Inter-Mortem Paper

Bryan Zhang
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The Green Ward is a thesis project is aimed at capturing the unique experience of being
hospitalized in a pediatric ward with cancer. The game aims to simulate the constant struggle against
boredom and fatigue that occurs from a patient’s perspective, which naturally lends itself to mentally
escaping as a coping mechanism or way to amuse oneself. The game also hopes to get players to
empathize with cancer patients on a more human level.
The game’s narrative follows Karen, a cancer patient who was in remission but is returning to
the pediatric ward because her cancer has relapsed. Her doctor tells her that she has a week left before
the intensity of her chemotherapy will force her to stay in a room in the isolation ward, where she will
be forced to stay indoors for the duration of her treatment. Karen wants to spend time in an outdoor
garden space at least once more before she is forced into isolation. In order to reach the outside
however, she must manage her stamina, symptoms and mental well-being.
The player assumes the role of Karen and alternates between guiding her through the daily
routine of inpatient life in the hospital, with playing as her empowered avatar in her dreams. Gameplay
in either realm will influence or be reflected in the other. For example, successfully completing or
achieving an objective in a dream level will improve Karen’s stamina when she wakes up back in the
ward. Alternatively, entering a dream level while Karen is fatigued in the ward will cause the dream level
to escalate in difficulty.
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The Green Ward was intended to appeal to both those who were unfamiliar with cancer
treatment and people who personally had gone through cancer treatment or were close with someone
who had.
The goal of the project for those unfamiliar with cancer was to help de-mystify the “scariness” of
cancer treatment or shed light on overlooked aspects of inpatient life. Another goal was to have these
players empathize with and better understand cancer patients and their experience.
For players who have had cancer or been closely involved with a cancer patient, the game is
intended as a therapeutic game or way to feel better represented in games. The hypothesized appeal for
this demographic is partly based on personal experience consuming media and fiction related to cancer
during treatment.

Prior art research for project has been an ongoing process as the overall design of The Green
Ward has shifted and changed over the course of thesis year.
The initial proposal for The Green Ward included extra game mechanics, as well as three other
major player characters. References for these included games and movies that involved ensemble casts
or switching between major characters (video games like Trine, Suikoden III, and Cave Story; films like
Cube, The Wizard of Oz, Rashomon). However, by the start of thesis year these elements were scoped
out of the project as I decided to focus the game more on the experience of being hospitalized.
To aid with this shift in focus, just before the start of thesis year, I paid a visit Lucile Packard
Children’s Hospital (LPCH). The pediatric transplant ward located there was the facility I had stayed at
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during my own bone marrow transplant. While there I did some site research by collecting reference
photos and notes on LPCH’s layout, facilities, and interior design.
I also met with doctors and staff to get feedback on the project. While talking to a former doctor
of mine, Dr. Rajni Agarwal, I was introduced to the Hopelab Foundation and the series of games for
cancer patients they had developed, Re-Mission and Re-Mission 2, which were interesting prior art
examples of other games about cancer. I also talked at length with one of the social workers who
worked with the pediatric patients at LPCH, Kate Yablonsky. We discussed the various emotional and
psychological issues that kids in the hospital go through, such as peer isolation, body image issues, and
friction with parents. Talking with Kate was a helpful process to refresh my own memories of going
through treatment and also to gauge what were similar issues that other patients also went through.
The discussion also convinced me that I wanted to The Green Ward to cover more of the emotional
experience of going through treatment.

With these initial thoughts, I met with several members of the IMGD faculty to get further
feedback and advice on the direction of the project.
I met with Tracy Fullerton and had her try out a thesis prototype I had worked on the previous
semester. She commented that hearing me talk in person about my memories from treatment was
compelling, but not every detail of my experience would be relatable to other cancer patients or other
people necessarily. She stressed that it was important to focus on who the project was for, remarking
that her personal experience with cancer treatment made her very reluctant to consume any media
related to it. She recommended I abstract the experience of being a cancer patient to make it more
resonant (aspects such as being tethered to an IV pole or bedridden were more universal).
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My thesis chair Marientina recommended I focus on the emotional systems behind the game,
mentioning that my project featured three worlds as opposed to two; the world of the hospital, the
world of the protagonist’s dreams, and the world of the garden, which is seen as the ultimate goal as
well as a metaphor for becoming healthy again. Marientina also put me in contact with Kathy Ruccione,
the nursing administrator for the Childrens Center for Cancer & Blood Diseases at Childrens Hospital Los
Angeles who would become my external advisor.
When I went to meet with Kathy at CHLA, we discussed various avenues to take my project as
well. When I brought up Hopelab and potentially working with them, Kathy said that I would have to
clearly define a change in patients’ behavior and state of mind first, and how you would measure any
changes before or after playing. She also recommended I look at various other media including Flower,
Cloud, and The Fault In Our Stars. Kathy also referred me to Teen Impact, a group of cancer patients and
survivors that met every other week to have dinner and talk in counseling sessions.
I ended up attending several of these meetings over the course of the semester and had
different attendees try out different prototypes and give me feedback. Participating in some of the
counseling sessions was also helpful reminder for me of the issues I experienced while going through
treatment.
Throughout the semester, I also attempted to work on narrative and explore potential narrative
content in Maureen McHugh’s Advanced Interactive Writing class. There were several interesting pieces
that I was able to finish in the class. One I passed along to my adviser Marientina, who suggested I
prototype based on the verbs I used in that piece. At the end of the class I produced a game design
document which was helpful to imagine the potential scope of the project. I received feedback on the
GDD from Maureen and my fellow classmates, which brought up several concepts that I had not
considered before.
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One of the first prototypes created during thesis semester was an initial attempt at a fantasy
world that would metaphorically represent a symptom that Karen, the protagonist, would be going
through. For ease of prototyping as well as conveying surreal and vast space, the prototype was made in
3D and from first person POV. The prototype ended up being an abstraction of a patient’s struggle with
nausea as a struggle to maintain the walls of a shelter during a dust storm.
The second prototype developed aimed to create more of a system in the game as well as
capture the feeling of fatigue and tethered movement that comes from being attached to an IV pole.
The prototype incorporated a stamina wheel that would decrease over time, affecting movement speed,
with an IV pole mechanic that required players to input “grabbing” the IV pole in order to move.
In thesis class I ended up showing both of these prototypes. I would have people come to my
desk and I would convey the keyboard controls to them, then have them play web builds of the levels on
my laptop. After having them play through both levels, I’d ask for their general feedback.
Several people remarked that the rough placeholder artwork for the stamina prototype was
compelling for them. Others remarked that they wished the input for moving/getting up/grabbing the IV
pole was more complex or unresponsive to better communicate the difficulty and fatigue of the patient.
Others remarked on the nice contrast between the 2D, limited perspective of the hospital and the
expansive, open 3D feel of the dream/fantasy level.

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In addition to figuring out core mechanics and experience through prototypes, I also kept trying
to draw inspiration for gameplay through art direction and character design. I invested time on iterating
on different looks and attire for the Karen and her dream avatar. I gathered visual references and
images and used personal experience to determine what would be believable attire for a teenage girl
living in a pediatric ward, and then used those baseline elements to inspire a more fanciful costume for
Karen’s dream avatar.
Both initial and later iterations of character designs were brought to Children’s Hospital of LA to
get feedback during Teen Impact meetings to receive feedback from the kids there. In initial visits I
mainly presented sheets of different character designs and asked attendees what they thought would
be a cool costume for a character to have in a game. In later visits I had a refined selection of three
different looks and asked a specific set of questions with regards to each character design (what do you
first notice about this character? What is your favorite thing about this character? If you could add or
change something about this character, what would it be?).

In addition to the main prototypes I listed above, and the art direction/character design work I
was doing, I also spent time with smaller prototypes. For example I spent some time trying out coding
different character controllers, different ways of animating the character in 3D and 2D environments,
and different prototypes for camera behavior in the game.

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Before the October showing I learned that people found the rough 2D aesthetic compelling
enough from an aesthetic standpoint. Some players suggested that the controls for the IV pole should
be more obfuscated or difficult, to better communicate the fatigue or physical strain that a cancer
patient would go through in dragging an IV pole.
Other players however found the controls confusing and difficult in the 2D prototype, but found
the 3D prototype very compelling and more intuitive
After showing both prototypes to Marientina, she commented that much of the aesthetic of the
dream world was misleading and too much like a vacation or beach aesthetic; not surreal or mysterious.
She commented also that for the fantasy level there was a lot of different things that seemed to be
going on which was overwhelming. Also that there needed to be something more to convey the kind of
environment I wanted (weather effects, sounds, environmental changes) and to make people care about
the space.
Marientina also emphasized that the prototype I had made was too complex and that I should
go simpler and create more of them; mentioning that I should work on 20-25 small prototypes that
could be resolved within 5 hours.

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By the IMGD Winteractive show, I compiled the four complete prototypes I had into one demo.
The first person bed POV level was repurposed as a main menu that would let players decide which
other prototype level they wanted to play, all they would have to do would be to stare at specific
objects in the room. From the bed, players could stare at an IV bag to be transported to the brownstone
level, look at the TV to play through the 2D Hallway level, and look out the window to play through the
3D Hallway.
The game was set up on two different stations, with a monitor in the middle relaying the
gameplay to passersby. As people came by, I would describe the overall premise of the project to them
and inform them of the relevant keyboard controls before letting them start.

Prior to the winter showing, I polled the class and professors on what they thought about my
thesis thus far. Many people responded that they felt my thesis project was a narrative piece/art project
as opposed to an explicit tool. Several people mentioned that I should stop trying to look for who or
what to design it for, and focus more on telling a story.
After Winteractive, I realized that I had had to spend a tremendous amount of time
communicating the overall narrative and controls to players who came by, which meant that none of
that was readily apparent in the game. The concept had to be relayed vocally, rather than being plainly
represented in the project. This clearly indicated there was a lot of work left to be done in incorporating
that content within the project. There were also usability issues as the control scheme and some of the
camera switching in levels confused people. In terms of aesthetics, some playtesters commented that
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the dream world and did not feel surreal enough and others found the graphics plain in other parts of
the game.
In response to winter show feedback I decided not enough emphasis was placed on who the
patient was. I felt it was important to develop more of a narrative before implementing any changes to
avoid the pitfall of focusing too much on cancer treatment, and not enough on the patient. Part of this
process included developing more of Karen’s personality and backstory in some brainstorming sessions,
more writing exercises, and through more storyboards.
Also, previously there was a unique opportunity to use the differing aesthetics of my hospital
world and dream world prototypes. The hospital was prototyped in 2D while my dream prototype was
done in 3D. This was a potentially nice aesthetic choice as 2D could suit a level that was more about
restrictions and limited movement in contrast to a more free roaming experience in a 3D dream world.
However I decided that it was important for to convey the unique spatial qualities of the hospital, so I
decided not to go with that visual logic.
More recently, after meetings with advisors, I have focused on solidifying the overall systems of
the game and making decisions on the extents of its narrative. Also I’ve put forth effort to be more
experimental in the environmental design of the levels in the game, trying to be less restricted and
attached to image references and site research.

Initially I struggled with trying to decide the course of my project. Very early on, I tried looking
for some tangible social or therapeutic benefit a project like this could provide. Eventually, I had to
accept that this was largely an artistic personal narrative and less of a therapeutic game. In hindsight, it
would have been neater for the project to have finalized a story first, before proceeding ahead with
production. Alternatively, I might also have de-prioritized art direction and instead focused more of my
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efforts on rapidly prototyping more varied and different interactions to finalize the systems and core
interactions in the game sooner.
In terms of production, I should have been more personally proactive and aggressive about
recruiting members and acting as my own producer earlier on in the process. I feel like a fair amount of
time was spent working and preparing for the team instead of having them to help me through the
design and prototyping process.

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50/50. Dir. Jonathan Levine. Summit Entertainment, 2011. Film.
Anthropy, Anna. Dys4ia. Newgrounds, 2012. Web. 16 March 2013.
Atlus Persona Team. Catherine. Atlus, 2011. Playstation 3.
Caballero, Vander. Papo and Yo. Minority, 2012. Computer software.
Green, John. The Fault in Our Stars. New York: Dutton, 2012. Print.
Green, Ryan. That Dragon, Cancer. Independent, 2013. Indiecade Demo. 5 October 2013.
Keene, Nancy, Wendy Hobbie, and Kathy Ruccione. Childhood Cancer Survivors: A Practical Guide to Your
Future. Beijing: O'Reilly, 2000. Print
Keene, Nancy. Childhood Leukemia: A Guide for Families, Friends & Caregivers. Beijing, ; Sebastopol,
Calif.: O'Reilly, 2002. Print.
McDaniel, Lurlene. Six Months to Live. New York: Bantam, 1995. Print.
Realtime Associates Inc. Re-Mission 2. Hopelab Foundation, 2006. Web. 1 October 2013.
Realtime Associates Inc. Re-Mission. Hopelab Foundation, 2006. Computer software.
The Fall. Dir. Tarsem Singh. Roadside Attractions, 2006. Film

Abstract (if available)

Abstract The thesis project, The Green Ward was an effort to highlight less explored aspects of the pediatric cancer patient experience in media and to portray patients in a unique manner that promotes empathy and understanding with the patients' condition instead of indifference, pity and/or aversion. The interactivity in the project focuses on the limited mobility and stamina of patients in the hospital, and their need for mental escape.

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Asset Metadata

Creator Zhang, Bryan (author)

Core Title Traversing the Green ward

School School of Cinematic Arts

Degree Master of Fine Arts

Degree Program Interactive Media

Publication Date 05/12/2014

Defense Date 05/12/2014

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag cancer,Dream,female protagonist,green ward,interactive game,leukemia,OAI-PMH Harvest,oncology,pediatric

Format application/pdf (imt)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Gotsis, Marientina (committee chair), Kratky, Andreas (committee member), Ruccione, Kathleen (committee member)

Creator Email bryanzha@usc.edu,runskarr@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c3-412934

Unique identifier UC11296036

Identifier etd-ZhangBryan-2507.pdf (filename),usctheses-c3-412934 (legacy record id)

Legacy Identifier etd-ZhangBryan-2507-1.pdf

Dmrecord 412934

Document Type Thesis

Format application/pdf (imt)

Rights Zhang, Bryan

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA