Let me just start by saying: If you are reading this and thinking, “Who voluntarily takes medical board exams at 63?” You are absolutely right. Normal people do not do that. They take up golf from the Green tees, try to marry off their kids, and complain that the younger generation cannot drive. But me? I spent four precious months of my remaining life cramming for the ABIM boards like I was 26 again (minus the hair, memory, metabolism, and the ability to sit for more than forty-five minutes without making a noise when I got up).

The reactions were priceless. I got everything from polite confusion to open concern. One friend texted: “Wait, like THE boards? At YOUR age? Blink twice if you are being held hostage.”

My daughter, who is actually preparing for her first ABIM attempt, thought I was joking. A dad prank. Something to psych her out. My wife and kids, bless them, tried to be supportive, but you could see the eyes roll: “Oh God. The house is in trouble.” Even my arthritis and bifocals tried to talk me out of it.

But here is the thing: It was not a midlife crisis. I was not chasing a second wind or reliving my residency glory days. My board certification had lapsed. I did not need to recertify. My full-time outpatient practice was thriving. I had a busy clinic, a growing patient panel, the occasional spasm of golf, and a season of MLC cricket. Life was good. But something was missing. Medicine has always been the greatest love of my life. (Apologies to golf, cricket, and my spouse; but let us be honest, medicine never complains about my snoring.) I just was not ready to hang up my stethoscope. Not yet.

The Pandora’s curriculum

From day one, I was lost. Where to begin? MKSAP? Too dense, like lifting dumbbells with my eyeballs. Textbooks? Thicker than my waist, and with roughly the same flexibility. Memory? Let us just say my brain now works on a strict “need-to-know” basis. I routinely walked into rooms and forgot why I was there. I needed a GPS, not just to find the room, but to remind me what I was there for!

In my desperation, I began to subtly interrogate medical students and observership candidates like an undercover agent: “So you are studying for USMLE, huh? What kind of books are the cool kids using these days?”

I nodded sagely as they rattled off strange and mythical resources I had never heard of: UWorld, MedStudy, Boards and Beyond, Anki, Sketchy, Divine Intervention … it sounded less like medical prep and more like Marvel’s next franchise. Back in my day (a phrase I now use unironically), we had actual books. Pages. Margins you could write in. Highlighters that dried out because you fell asleep mid-chapter. Now? There is an entire Medical Universe. A multiverse, really.

There is UWorld, My Medical World, Your Medical World, Everyone’s Medical World. I half-expected to find “The Idiot’s Guide to Internal Medicine”! There are videos with animated T cells and anthropomorphic bacteria. Podcasts where people with suspiciously calm voices whisper esoteric facts about obscure enzymes. Flashcards with spaced repetition algorithms so advanced, I felt like I needed a PhD just to understand how to use them. There is probably a meditation app where a soothing voice teaches cytokines over the sound of Tibetan gongs and crashing ocean waves, by the way you can choose male or female voice. And everyone, and I mean everyone, promised me that I could pass the boards in just four weeks. Four weeks! I have had dental cleanings that required more preparation.

Eventually, I caved in. I borrowed (okay, fine, stole) a set of MKSAP pearls from my daughter, who had the good sense to highlight the good parts (which, let us face it, is basically all of it). And against my better judgment (and better financial planning) I bought a six-month subscription to UWorld. (Side note: UWorld should be paying me. Seriously. I am their ideal poster child: aging, overwhelmed, and eternally grateful.)

One Tylenol and two Advils later

The alarm was set for 6:00 a.m. every day. Ten UWorld questions before patients at 8:00 a.m. I had it all mapped out, like a military campaign. Every upper respiratory infection patient sent me spiraling into UpToDate. A little fatigue and joint pain? Clearly Lyme, or Ehrlichiosis, or maybe Rocky Mountain spotted fever. I did not know if New England had more deer, more ticks, or more textbook writers, but suddenly everyone seemed to have Babesiosis. I started diagnosing it in my sleep.

Meanwhile, my golf buddies staged a quiet intervention. “You are studying for WHAT? At YOUR age?” one of them asked, holding his nine-iron like a sword. “What are you trying to prove?” I did not have a good answer.

There were nights I sat in bed frustrated and exhausted, questioning everything. I would sit on the bed, bleary-eyed at 11 p.m., reading about Hyponatremia and wondering if I had it myself. I was not just tired; I was existentially fatigued.

But here is the thing: Dreams do not retire. They age. They sag a little. They might need reading glasses and an occasional B12 shot; but they do not vanish. Proving something to the world? That fades. Proving something to yourself? That stays. That is the whisper that keeps you going long after common sense says stop. I kept going through the distractions, the setbacks, the self-doubt. I failed most practice tests. I forgot things I thought I knew. But every time, I showed up. And every day, I thanked my two best friends: One Tylenol 500 mg and Two Advil 400 mg. Of course, I monitored my renal function, because UWorld made it abundantly clear: NSAIDs are no joke.

The study plan (a.k.a. the great humbling)

The first day I cracked open the review book, I remembered, very clearly, why I had avoided this for so long. Every page whispered menacingly: “You used to know this twenty-five years ago.” UpToDate became my new tee time. I practiced my golf swing while mumbling MKSAP pearls and three-putted every mnemonic.

UWorld became both my savior and tormentor. Their explanations were so detailed I sometimes forgot what the original question was. I would start trying to answer a Cardiology question and end up three layers deep into Nephron physiology and wondering whether aldosterone was a hormone or a house plant. Meanwhile, twenty-somethings made TikToks about Nephron physiology with cartoon kidneys and trending audio. Me? I was sipping masala chai, squinting at my iPad, chanting “RAAS system” like a mantra.

Endocrinology? What a rip-off. Every time I thought I understood it, they would throw in a question with four correct answers, and I would still pick the wrong one. My brain had cobwebs. My back did not like me anymore. My knees? My knees had full-blown opinions. And do not even get me started on monoclonal antibodies; every single one sounds like your neighbor’s Wi-Fi password. The people naming these drugs should be penalized and forced to spell them three times fast while sleep deprived.

I spent hours on practice questions, learning that “vague abdominal pain” is not a diagnosis, no matter how accurately it described my daily state. I also discovered that the only thing slower than my internet was my processing speed. I had to train my brain to look for buzzwords like a squirrel hunting acorn. “Malar rash?” Gotcha. “Cafe-au-lait spots?” Boom. “Low urine sodium?” Let us go. My daughter began avoiding the dinner table, for fear of being quizzed.

Guidelines and grudges

I am completely lost trying to follow, digest, and keep up with all the clinical guidelines. Take colonoscopy screening, for example; those guidelines have more bends, twists, and turns than the actual colon. I used to think the sigmoid was the trickiest curve. Turns out, it is figuring out whether I am supposed to screen at forty or forty-five or fifty, depending on the patient’s age, ancestry, insurance provider, number of polyps in the patient or first degree relative! So now, the moment my patient turns 45, I send them directly to my favorite GI guy. No discussion. No hesitation. “Happy Birthday! Here is your bowel prep and a referral.” Let him earn his money decoding the ever-changing map of colon guidelines. I do my part. I refer. I care. I sleep at night.

I am not waiting around for my patient’s pulmonary artery pressure to hit 50 mmHg before referring them for asymptomatic Mitral Regurgitation surgery. That is not a referral. That is a eulogy. No sir. The minute that pressure crosses 20 mmHg, I am speed-dialing my cardiologist friend. Why? Because I believe in proactive care.

I read them. I annotate them. I even pretend to understand them. But after a while, they start to blur together: ACC says one thing. USPSTF says another. The specialty societies chime in, and before I know it, I am knee-deep in another muddled question.

Honestly, I am convinced I need to join the ABIM question-writing committee. Not to help, to confront. “Gentlemen, what childhood trauma made you write these questions and inflict pain and suffering on unsuspecting physicians? Who hurt you?” (I say this with love. Mostly.)

Exam day: a comedy of errors

The night before the exam, I followed my own advice: “Get a good night’s sleep.” Naturally, I tossed and turned, checking the ABIM website at 2 a.m. hoping for divine intervention or a rescheduling glitch. I demanded a care pack from my children (payback for all the ones I made for them).

• Chocolates (for brain fog)
• My favorite candy
• And of course, my best friends, Tylenol and Advil

My wife packed me like I was hiking one hundred miles: snacks, sandwiches, water, orange juice (labeled: “IN CASE OF HYPOGLYCEMIA: BREAK SEAL”), and Coke Zero. And for good measure, I added an extra pair of glasses, 40 mg of famotidine, and my lucky pen, which by the way, was promptly confiscated at the testing center. “Sir, lucky pens are not on the approved materials list.” Thanks, ABIM. I will just rely on pure fear now. As I left, my daughter handed me a sweatshirt and said, “Dad, it gets cold in the testing center.” I did not feel brilliant. I felt old. Grateful, but old.

I arrived one hour early, because at this age, punctuality is a personality trait, not a choice. Checking into the exam center was like trying to get into the Pentagon with a secret identity. They scanned my palms, inspected my glasses under some mysterious rotating machine, to make sure they were not “smarter” than me, I suppose, and made me turn out my pockets inside out like I was smuggling beta-blockers. Feedback: ABIM, please consider adding a retinal scan; you can never be too careful!

With adrenaline spiking and coronary arteries protesting, I sat down. First question? “A 52-year-old man presents with vague abdominal pain …” Of course he does. I am that patient. The physical breakdown begins. By halfway through the exam, my back was filing for separation. My bladder joined the rebellion: “Just for your information, symptoms do not correlate with PSA, but something is about to happen.” I was doing Lamaze breathing in the final stretch, not from anxiety, but to stop myself from physically fleeing the building. By the last question, I was using sheer willpower and an inappropriate amount of caffeine to keep my head up. My eyes were bleary, my brain was fried, and my spirit had temporarily left the building. But I finished. Dazed. Drained. Dehydrated. Weary. Bleary. But done. “Never again. Until ten years from now, apparently.”

The result: at last

The ABIM website says your results will be available in three months. Sounded suspicious. I wanted my result the moment I clicked DONE! Why so long? I imagined the Question Marking Committee sitting down over a cup of Macchiato, scoring every question manually and laughing at my stupid answers, but then they are the ones who wrote the question! The joke is on them!

I waited. Honestly, I am not lying, I checked for ABIM email every day, including spam. I logged into the ABIM website twice a day to check my profile, to see if magically I was recertified! It arrived. It took them one month to mark my paper! It simply said, “Your ABIM assessment results are available.” Seriously! You could have said Hello, Good Morning, Congratulations, Sorry, or something!

I stared at the link and my sharp, devious mind raced dreadfully through all the options. “Just open it.” “No, what if it says FAIL?” “Well, then we cry, eat carbs and go play golf.” “What is a score anyway?” “A test does not define me.” “The real exam is life itself.” And I am already doing busy medical practice; I did not need this.

Finally, after mentally preparing for both glory and devastation, I clicked. I read the word once. Then twice. Then I took off my glasses and put them back on to make sure my eyes were not hallucinating from stress or sleep deprivation. “CONGRATULATIONS.” One simple word. You had me at one simple word. One huge exhale. One full-body moment of disbelief, joy, and quiet triumph. With a weight of 63 years on my shoulders, I got up.

Passing the medical boards at 63 did not just renew my credentials; it renewed me. I walked out of that experience with a certificate in hand and a reminder in my heart that it is never too late to chase what matters. Ambition does not have an expiration date. And to anyone out there considering a bold, ridiculous, life-reaffirming challenge: I would say go for it. Go sky diving! You might just surprise yourself.

Rajeev Khanna is an internal medicine physician.