Dr Clyde Cave steady under strain

By Geralyn Edward

He is the doctor who manages to elicit smiles from babies and children, even in the sometimes tension-filled environment of a hospital or his medical office. He is known for taking calls from frantic newbie parents at 2 in the morning, as calmly as he would at 2 in the afternoon. 

Today, though, Dr Clyde Cave carries a different burden of responsibility that has thrust him into the spotlight during this COVID-19 pandemic, as Director of Medical Services at the Queen Elizabeth Hospital (QEH).

As has been the case over his four decades as a medical practitioner, Dr Cave is solidly calm. He answers the questions shot his way at COVID-19 Press conferences in a straightforward manner, accepting that the facts remain the facts, even when others may disagree.

The signature on Cave’s emails offers a snapshot of his many roles. They are long and impressive. He is the hospital’s Senior Consultant Paediatrician and Neonatologist, Programme Director of the Shaw Centre for Paediatric Excellence at the QEH, a senior Associate Lecturer in Child Health at the Cave Hill Campus of the University of the West Indies, and a consultant to the Eastern Caribbean Neonatal Network. 

Hospital administration 

He also operates a limited private practice and still finds time for philanthropic pursuits.

While navigating the responsibilities that have come with his transition from hands-on medical care, to hospital administration, and the mentoring of young doctors, Cave told COVID Weekly, his desire is also to influence the direction of the QEH; to be part of the solutions, and not simply complain about the problems.

He is proud of the neonatal intensive care unit (NICU), in which he played a key role in establishing. He also admits that a non-negotiable part of his contract for his senior administrative role a year ago was an insistence that he be allowed to have at least a limited private practice.

He loves the fact that he is now attending to children, whose parents he cared for when they too were toddlers. He admits delight in the role he plays helping children to grow healthy and happy.

Cave said of his elevation at the QEH: “It came out of the realisation that in order to do the doctoring, you must have the support of all the other things that enable us to do the doctoring. If we don’t have the supplies, or the finances, or the appropriate nurses, or the long-term plan for integration into where the hospital is going as an organisation, then our ability to look after an individual is impacted.”

Lightheartedly blaming his late mother for his decision to seek a senior management role at the hospital, he quipped: “All I could hear was her voice saying, ‘If you are not part of the solution then you are part of the problem’.”

The hospital administrator’s drive to improve the institution’s efficiency has been stalled somewhat by the pandemic. He admits the deadly disease is consuming the human and other resources at an alarming rate.

“While part of the COVID-19 response is my primary responsibility . . . I am reminding people that even though COVID-19 is on our minds, we still have a lot of sick people in this country. Arguably, even more so, since COVID has interrupted our regular practice of health care. And my responsibilities are to make sure that they are not neglected and sidelined while rising to this additional challenge.”

MIS-C case 

Those multiple roles of hospital administrator, consultant pediatrician, and educator, intersected last month in a most dramatic and public way, when a nine-year-old child died of COVID-19.

The tragic death of the pediatric patient from COVID-19 was the first of its kind this side of the Caribbean. It became a point of discussion among regional health specialists because of its uniqueness, and the implications it had for management of the disease in the region.

The little girl’s passing profoundly impacted him and his colleagues, he admitted to COVID Weekly.  He was also equally disturbed by suggestions that this child did not receive the best care. 

And when information about her death was published in Trinidad and Tobago media before it was shared in Barbados, Cave faced a backlash, with suggestions that confidential information might have been shared in another country about the young patient.

“There was no leak of confidential information. What there was, was a discussion among doctors within the region of a case. There was no identification of the child. But that generic information was disclosed in another country before it was disclosed here.

“To speak in general, public health information terms . . .  very personal individual and confidential information is always a challenge.”

Furthermore, the senior medical practitioner felt much of the discussion was “a diversion” from what should have been the focus of attention. 

“That concern is this disease that so many people have been viewing as only affecting the old and those with comorbidities . . . reached and affected a child.”

According to Cave: “Children are always among our most protected and vulnerable members of our society and to see COVID-19 harm one, was a moment of national awakening.”

The child’s passing also impacted the medical team because they worked tirelessly to save her life.

“There is the assumption you could do something to prevent it. There is always the assumption that if a child dies, the care was not as good as it should have been. Both of those things are simplistic and downright wrong. The pediatric complications of COVID-19, Multi-symptom Inflammatory Syndrome in children (MIS-C), as we understand it now, is something that is unpredictable. We cannot tell which child infected with COVID-19 will develop this.

“We do know that some children will. And there is a spectrum of severity ranging from those who die to those who are critically ill and require intensive care.

“I am certainly confident that in the case of our country, a very high level of intensive medical care was provided in the Paediatric Intensive Care Unit by both doctors and nurses. And I certainly dispute that an unfortunate outcome, was an indication there was sub-optimal care.

“The care that children receive in Barbados, just because of our having both a new-born and a Pediatric Intensive Care Unit, is something that couldn’t possibly happen in many of our neighbouring countries, much less in some other parts of the world, because they don’t have the privilege of having those facilities.”

Emotional toll

Of the emotional toll the child’s death took on the medical team, Dr Cave remarked: “Those of us who have the responsibility for providing care always second-guess ourselves. Should we, could we, might we, what happens if it happens again, and is any part of it our fault?

“Oftentimes in medicine, even when intellectually you answer all those questions, and you know there is nothing different that we could have done . . .  you are still left with that emotional charge where your mind knows one thing, but your heart may feel differently. 

“Yes, dealing with the death, being on the receiving end of the calls when everybody was so shocked at how fast there was a turn and the eventual outcome. Yes, it does take a toll.”

Stresses of the pandemic 

Addressing the general concerns of staff at the hospital and the stresses attendant with the pandemic, the Director of Medical Services shared that at times, it can be emotional and overwhelming.

The long hours on the job, the fears of medical teams that they could become infected and spread the disease to family members, have added to the stress of the situation.

But with the pandemic, he said, has also emerged a determination by hospital staff to remain steadfast to their jobs and commitment to high-quality patient care.

Cave, who has been a mentor to scores of young doctors at the QEH, noted: “I am convinced that a lot of the very hard work that is being done, extra work being performed, and the risk to personal safety and family security, is done because the doctors and nurses believe our profession is a higher calling. Yes, you will obviously get people who are in it for other reasons.

“. . . We have not been faced with massive sickouts because . . . people have generally tried to pull together to address the situations, in the best way we can as doctors.”

With 21 confirmed cases of COVID-19 among QEH employees this year, Cave said all precautions are being taken to ensure that those numbers do not rise.

But he said, if it does, it will be a reflection of increases generally on the island. 

“The only real tools we have in prevention, is the vaccine, social distancing, protecting with face masks and facial shields, and good hand hygiene,” he said. Cave noted that if everyone does not employ these precautions and the viral illness continues to spread, then more infections in the hospital will follow. 

Asked whether the QEH had reached the point of being overwhelmed, the senior administrator put it this way: “We are not overwhelmed yet. When you look at the news from other places, you are very aware of how quickly this situation can change from people who think they are doing okay, to suddenly, every resource is in use. 

“There are parts of the system that seemed to be at bursting point. There have certainly been times when our Accident and Emergency Department has had more patients than we would want to be comfortably coping with. But then they move on to other parts of the system, whether that is into the Isolation Facility, if their disease is COVID-19-related, or into the hospital if it is not and their illness requires hospitalisation.

“At the moment, we are relatively lucky in that the large number of people being identified with COVID-19 are at the milder end of the illness spectrum. However, there are the special cases where due to comorbidities or bad luck, are on the more severe end of it.”

Cave’s message to Barbadians is simple. “We have to do what is needed to get through this, in the best way we can.”

He is not keen to look back and “fight phantom enemies”. He observed: “We are an intelligent and caring country, and we have put a lot of our resources toward the tools we need to fight this. 

“We have a vaccine, and we should use it to the maximum. We have a system of identification, isolation, and containment of infected persons, and we should do our best to support that, rather than trying to find ways around it. 

“We have plans, guidelines and protocols, curfews and population density measures, that have been shown to work and we should try, in the spirit of these, to make them work as best they can and not find ways to beat the system and make exceptions. 

“This is a disease that can’t be fought by a single person or doctor, this requires a community effort because the health of individuals also impacts on the health of us all.”

This article appears in the March 1 edition of COVID Weekly. Read the full publication here.