The Hand of the Beholder

August 4, 2007

One of the most difficult conversations you can have as a physician is to have to inform new parents that their child has a "birth defect." As I stated in a previous post, I like to tell parents that their child is "perfect" whenever I can, but the feeling of knowing there is something wrong with a child when the parents don’t yet know is one all pediatricians would gladly avoid.

One of the more common problems we see in newborns is polydactyly, a condition where a child has an extra digit on the hand or (less commonly) the foot. It most commonly happens in the location pictured on the right - just lateral to the 5th digit. The extra digit is usually non-functional, and smaller digits can often be removed before the child leaves the hospital.

This condition occurs in 2 in 1000 live births, and is autosomal dominant, meaning that a parent with a history of polydactyly has a 50% chance of passing it on to their child. It is occasionally associated with other more serious syndromes, but is typically an isolated abnormality.

One of the most famous fictional case of polydactyly is in the movie The Princess Bride (which is one of my all-time favorite movies). One of the heroes in the movie, Inigo Montoya, is obsessed with chasing down a six-fingered man who killed his father many years before. When he finally finds the six-fingered man, he fights him to the death, repeating the phrase, "Hello, my name is Inigo Montoya. You killed my father. Prepare to die."

So my office partner was at a delivery recently, and he noted the child had an extra digit on one of his hands. The nurse quickly pointed out to him that both hands had an extra digit coming off of the side of the 5th finger. He had the predicted feeling at the pit of his stomach as he prepared to explain this "imperfection" to the parents, when the father came up and got his first look at the new baby.

"Hey, he has extra fingers on the side of his hand!"

He turned and held his hands up to my partner.

"I had extra fingers when I was born," he said, showing two barely-visible scars. "I had them removed when I was an infant."

"Hey honey," he said to his wife, "he has extra fingers just like I had when I was born."

There was a brief pause. My partner held his breath.

"He does?" she asked. "Awwww….he has extra fingers just like his daddy! Isn’t that sweet?"

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