Here's the final painting. I decided to use very limited color.
Below are the steps I took to get to this final result.
1. I work in monochrome. Decide to wipe this attempt off and start over.
2. working with just raw umber and a quick dry gaylkyd white.
I am not satisfied with the hand and coat.
2. I try to interject a knife into the picture, putting it in the man's hand. I like the mystery in the shadow under the hat but not the shape the knife and coat make.
3. Here I add some strange and sinister medical instruments to the coat. I like it better but I lost some mystery in the shadow under the hat. Finally I work into the whole picture with color and you see the result in the first image I posted.