“Losing The Coin Toss”



By Anthony Kovatch, M.D. — Pediatric Alliance, Arcadia Division




“And risk it on one turn of pitch and toss

And lose, and start again at your beginnings

And never breathe a word about your loss.”

(– From the poem “If’” by Rudyard Kipling, written in 1895.)


No one, not even the players themselves, will long remember who won or lost the coin toss igniting the spectacle we call the “Super Bowl”.  This ritual has little impact on the outcome of the game or on the long term quality of any individual’s life.  In great contrast is the outcome of the coin toss which occurs at the moment of conception of every individual, when the genetic consequences of a lifetime are determined.  Heads, a life of promise and fulfillment of dreams – either for the conceptus or for the parents; tails, a life of anxiety, hardship, and tears – either for the afflicted or for the loved ones.  Ironically, the lucky ones know the outcome at birth or shortly after (Down Syndrome, Sickle Cell Disease, classic Autism) and the trajectory of the lives of those who love them can be adjusted to achieve happiness – acceptance will be prompt.  In stark contrast are those diseases which can destroy one in the prime of life after dreams have been partially-realized and the offspring and spouses pay a major toll (Diabetes, Huntington’s Disease, Bipolar Disorder, Alcoholism).  In these conditions, it is said that the victim is paying for a crime that he cannot remember – the “crime” was simply losing the coin toss and acceptance may be unachievable.

Years ago as a pediatric resident, knowing nothing of life or love, I committed an act of cowardice known only to myself and the middle-aged mother whose child  I evaluated in the emergency room.  He was her second child with Werdnig-Hoffman disease, a fatal progressive neurodegenerative condition which renders the child limp and expressionless.  Before I commenced with the family history, she stated that she had an older son with the same fatal condition.  Astonished, I summarily became a social judge:  “So you knew this and you still had another child!”  Immediately her expression changed to an icy cold rebuttal and my pedantic display of genetic “wisdom” transmuted into the silence of shame.

Our eyes never met again.  I realized that her first loss of the coin toss was merely bad luck; her second loss was defiance of the laws of statistics and safety, and a reflection not of foolhardiness, but of courage.  Years later I understood better this universal dilemma within the hearts and minds of mankind when I read the closing line of Colleen McCullough’s epic novel, The Thorn Birds:

“The bird with the thorn in its breast, it follows an immutable law; it is driven by it knows not what to impale itself, and die singing. At the very instant the thorn enters there is no awareness in it of the dying to come; it simply sings and sings until there is not the life left to utter another note. But we, when we put the thorns in our breasts, we know. We understand. And still we do it. Still we do it.”


There is no insurance for the consequence of losing the coin toss.  No high deductible life insurance.  No amount of vaccinations, broad spectrum antibiotics, or epigenetic manipulations can alter the outcome.  Not  fundraisers, not the rhetoric of politicians.  Maybe gene transfer therapy someday.  And we know that love does not always conquer all.  I think that only by the courage to accept the suffering can we prevail.   That,  and an occasional miracle:

“The years after the war had not been kind to him, years of starvation, watching his peasant father struggle and eventually commit suicide, unable to process the lingering bitterness of the war.  He had become a race car driver for awhile, daring death, defying it, and it was his lack of fear that made him rich… He attacked safety problems like a Kamikaze pilot… because there was no risk in business, no risk in life, no risk in losing money, no risk in anything.  People paid him gobs of money to control their risk, because they did not understand that there was no such thing as safety, no such thing as control… and control, he had learned, was the greatest risk of all, because safety leaves no room for miracles.  And miracles, he had learned, were the only sure things in life.”  (– From Miracle at St. Anna by James McBride.)