I usually just have a thumbnail and go for it in photoshop, but I actually did the drawing on paper so I have all my steps.
I had the image of the fragile woman and her ring finger in the beam of light idea in my head, doodled it out.
Then I had to back up to see where the beam of light would be coming from to make that angle on the bed.
Sketched out version
Final sketch with values laid in with more pencil work and the levels altered in Photoshop.
Added photoshop values to block it out even more.
Then I added colors and kept tweakin! Final is at the top o'course.
I even drew the couple in the frame on a different piece of paper.