In 2013, the 23-year-old game artist and developer Samuel Coster hallucinated a dragon made of blood bursting from his chest. The hallucinations continued and soon increased in regularity. “I figured I was struck with a strange virus,” Coster recalled, in a session titled 'The Last Game I Make Before I Die' delivered at the Game Developers Conference this morning.

Coster began to work out. He changed his diet. The hallucinations continued and he began to feel lumps on his chest. He went for a medical examination. “The doctor's assistant practically ran out of the room when she saw my chest," Coster said. "She came back with a doctor.” During the next few weeks, Coster underwent a slew of tests and biopsies. Each came back with a worse prognosis. Coster had stage 4b lymphoma, a cancer of the lymph system. His projected survival rate was just seven percent.

A tearful Coster asked the San Franciscan audience to bear with him, as he’d decided to "not leave anything off the table" during the session. The worst thing about receiving a terminal diagnosis, he said, is the underlying sense that you’re doomed. “It forces you in no uncertain terms for confront and deal with death.”

The day after his first chemotherapy session, Coster and his brother, who for eleven months had been making games under the moniker Butterscotch Shenanigans, sat down to look over the design for an endless runner that they had been planning prior to his diagnosis. He wanted to do something so ambitious he would have to stay alive just to do it. “I wanted to do something that mattered -- not something just to make money,” he said. “It forced the question: what would I do if I was gong to be dead in a year.”

Coster began to approach his life with a game designer's eye. “Do I want to do this? Does this make me fulfilled? Is this worth my scarce time? It forced me to consider what I'd need to change to give myself the best experience in the time I had left.” Coster and his brother, who is a programmer, abandoned the endless runner to work on something more ambitious – a crafting-focused adventure game that would eventually be released as Crashlands.

Coster would create art for the game using a mouse from his hospital bed. The work was therapeutic. “The truth is that making games while gong through treatment made the treatment easier, and vice versa,” he said. “It also became therapy for my brother. He could feel helpful in a helpless situation.”

With what he described as “an intense, dragging sense of fatigue” from his chemotherapy treatment, Coster and his brother came to GDC in 2014. “Everyone we met with was completely unimpressed,” said Coster. The pair returned from GDC “down but nevertheless inspired.” When Coster’s sixth and final cancer treatment was finished Coster and Seth took a day off to celebrate, then got back to work.

“I realized I wasn’t going to die,” he said. “That turned out to give me a lot of work do.” It was not, however, smooth sailing for Coster. Over the course of the next two years, the cancer kept returning. He needed two stem cell treatments. “My world exploded,” said Coster. “I felt like I’d gained so much from my first experience with cancer, but to go through that again was utterly dispiriting.”

By this point Crashlands had, Coster said, become unwieldy. At the end of 2014, the game was still in development hell. It wasn’t anywhere near done “I was in a dark place,” he said. “My feeling of having a future was obliterated. I’d throw up every few hours. Hope was in short supply. The future looked bleak.” The game, however, provided a focal point for his thin attention. “I’d focus on the very next asset I needed to build for the game.”

In the midst of this despair, Coster, Seth, and their third bother Adam, who had by now joined the nascent studio, brainstormed how they could make their game stand out. The brothers decided to create humorous quests as a way to bring comedy and levity. At the time of GDC 2015, Coster was advised by doctors not to go to the conference, as his immune system was heavily weakened. Coster went anyway. Two months later, in May 2015, Coster received his first stem-cell transplant, which, along with a highly potent chemotherapy regimen that killed his bone marrow, had such a profound effect on his well-being that development on Crashlands was put on hold. Eventually Coster managed to, for a few minutes each day, create some small pieces of art for the game.

Shortly after the game’s trailer launched on Steam and the game was Greenlit by the community for release, the brothers began sending the game to user testers. In December, Coster underwent a PET scan to see if there was any cancer in his body.

“I waited in the doctor's office for an eternity, She finally told me the news: there was nothing on the scan. The cancer was gone. The blood dragon that had plagued me for two years was dead.” Twenty-four hours later the brothers set the launch date for Crashlands as mid-January 2016.

“The lead up to the launch felt similar to that scan,” he said. “We’d done everything we could. Now we were simply waiting for the market to tell us if we’d done things correctly.”

The story behind the game’s conception and the role its development played in Coster’s life isn’t clearly alluded to in the game itself. But Crashlands represents, Coster said, a suit of armor, a retreat from the cruelties of the world. “I’d arguably done my best work, motivated by cancer,” he recalled.