The child on the cover is Marcia, age 5. I modified the original image heavily, mostly by adding blur and killing much of the contrast. And it's a severe crop, which helped kill detail.

For a long time, neither Marcia nor I were satisfied with the face image plus titling. I tried color washes, different titling fonts, adding grain . . . nothing worked.

Then I had the idea of taking one of the medical reports Marcia uses as chapter headers, rendering it in a typewriter font, and dropping it over the face.

I usually use a title font on the covers, but that didn't work for this one. Also, although having the subtitle directly under the title is common, that just didn't work visually.