I painted how I imaged the giant figure of Caine, as of the First City. The two heads on each shoulder are his Beast, THE first Beast. And on the other, the pale and withered corpse-aspect of vampires, immortal and static. And in the darkness in between is the predatory intelligence of Caine. And around his shoulders is a cloak of deepest darkness, stolen from the Abyss.
The howling shades in his belly is more symbolic than literal, they are all of his victims throughout time and space, crying out in lamentation.