This is a rare instance of Robert working with pencil in a study for a painting. The drawing features two  children, while the painting has three. The drawing also shows a deck of cards scattering through the air, partly obscuring the bodies of patient and family. The idea is that the success or failure of any given cancer treatment is largely a matter of chance. Robert makes no effort to explain the presence of the cards, giving the image an air of mystery and foreboding. In the finished painting, one of the children holds a deck of cards, a more understated treatment of this symbol. The complex layering of one element on top of another is both dazzling and confusing, which is no doubt why Robert simplified his image before attempting the large scale painting.