Ohhh....Nice use of monotone here, but it gets dark around the top of the patient's head so it's hard to see exact details between the background and the very top of his skull.

i don't think that the problem is that it's dark
the problem is that it's light everywhere else.

poor distribution of contrast

Well, you know I'm already quite happy with your work for Heat, but I thought I'd say something here too. Printing the dark tones will be interesting, but from what I can tell so far, you can see separation of dark gray tones better in print than on screen, so there shouldn't be much to worry about. I do like how the small areas of light tones really pop out at you in contrast to the dark areas surrounding them - like the surgeon's jacket, the towels behind him, and the sheet draped over the patient.

dark tones always get killed by glare on a luminous display like a monitor

paper doesn't overload the senses like a maladjusted monitor (like mine) does