The moment I saw Josh's book, I thought of Goodnight Moon. The Maxim magazine sitting by his bed represents how he might have entertained himself while bed ridden. The flowers and balloon represent all of the people who were thinking about him and reached out to him while he was recovering. Lance Armstrong jumping over the moon represents two things: 1) I figure Josh was so drugged up at some point for pain management that he might have hallucinated a few things here or there; and 2) Josh's world was momentarily shattered just as Lance's was (although I realize they are very different circumstances).
I decided to stick with a pencil sketch since that is how Josh started his book; I enjoyed the lack of pressure to spice it up with color.