Watson

It's been a long road, but I think we're there.

You have a viable embryo.

-Are you sure? -I'm about as sure as I can be.

We've ruled out any major chromosome abnormalities,

and the single-gene conditions we can screen.

As long as the implantation is successful,

you can have a viable pregnancy.

Wow.

That is, uh...

Thank you.

Thank you.

I need to call my husband and tell him the good news.

-Of course. -Thank you.

You're very welcome.

Huh. Identical twins.

Do you just do everything together?

-I applied here first. -We have different specialties.

Something tells me Dr. Watson's gonna have

a field day with you two.

Well, I'm not sure what that means,

but I'm hoping to utilize Dr. Watson's work

on immune pathways to fight infections.

I was thinking of something similar.

Are you an immunologist? Me, too. And rheumatology.

I'm double boarded.

- I'm infectious disease, actually. Oh.

Interesting.

Maybe we can work on a project together.

Everybody says that Watson is good and fair...

Clearly into competition.

Should we make a bet about who gets cut first?

Why would he hire all of us just to turn around and cut one?

Oh, let me guess, family medicine?

Not far off.

Functional medicine.

Oh. Okay.

Let me help you understand.

Watson either has

one too few desks or

one too many fellows,

and he's had ample time to get another desk.

Or maybe

it's a hot desk situation.

So, you're a "glass-half-full" type. Got it.

Ready for our first official day, guv?

I am.

Just got to do a little decorating first.

Holmes's violin.

Feels like he could just walk in,

play us a tune, solve a mystery or two.

Yeah, I wish he could.

We'll just have to honor his memory with our work.

Fellows here yet?

Down in the bullpen.

One concern. You asked me to order four desks.

There are five fellows.

Hmm.

Seems like this desk has already been claimed.

It's mine.

Been here for a week, working on our first case.

Thought I'd make myself at home.

I'm sure you four can make the three other desks work.

You're the one who cuts, aren't you?

Paola Barajas. Surgical specialist.

Ingrid Derian, neurologist.

My bet is Miss Glass-Half-Full is the first to go.

Nobody's going anywhere.

And don't underestimate me.

Fellows.

Good morning.

Happy first day. Welcome. Et cetera, et cetera.

Why don't we meet in the conference room?

Kyren Garner. 16.

He has been my patient since before his birth.

I worked with his parents during my genetics fellowship

to help them conceive.

So what's his deal?

I just assume there must be a rare genetic condition at play

if we're here discussing him 16 years later.

- That's correct, Dr. Derian. - You're half-right.

Kyren has VACTERL association.

VACTERL patients have multiple anomalies.

The name is an acronym.

It's a disorder that really means

"a bunch of disorders."

Each letter stands for a different body part

- that can be affected. - But it's not genetic.

There's no clear cause, and since you can't test for it,

it's hard to diagnose prenatally.

Correct.

We knew Kyren had a VSD from a sonogram.

So, you knew he had a heart condition,

but you need three of these anomalies

to be diagnosed with VACTERL.

It was at his birth that we learned

Kyren had two more:

a tracheoesophageal fistula and

a malformation of his lower GI tract.

That gives him VACTERL.

Poor kid.

That means he had several surgeries

soon after he was born.

Yes, he did.

Kyren learned to walk in the PEDS ward,

after a G tube revision.

And then, he celebrated his seventh birthday

here at UHOP once we

readmitted him for one of his chronic UTIs.

He and his family must've spent more nights

in the hospital than at home.

Well, it's just mostly he and his mother now.

His medical needs were a lot for his father.

Kyren has had over 12 surgeries

just to simply rebuild his body.

And even so, at 16,

he was accepted to Penn State for robotics.

Though he had to defer.

But tomorrow, I'll perform his final surgery

to fuse his spine and correct his severe scoliosis.

We'll get Kyren to college

sooner rather than later,

but I'd like you all to acquaint yourselves with this case.

Dr. Barajas and I are gonna meet with Kyren and his mother.

But they were my first patients when I was a fellow.

Now, they're yours.

Sorry, Dr. Watson,

I couldn't help but notice there are only four desks.

Hmm.

I'll have to look into that.

- Oh, thank you. - Mm-hmm.

Wow, this is definitely an improvement

over that tiny office I met you in.

Isn't it?

Yeah, you're really coming up in the world.

They built this entire clinic for you?

Well, for the advancement of genetics

and the education of a select group of fellows.

-Dr. Paola Barajas. -Hi.

-I'll be doing Kyren's spinal fusion. -Nice to meet you.

Yeah. You know, I'm gonna have my own robotics clinic one day,

just like this.

Better than this, maybe.

Well, if anyone has the brains and perseverance

to accomplish their dreams, it's you, Kyren.

Yeah. Now I just need the body.

-Kyren. -What?

Dr. Watson understands my need for bodily improvement.

Our plan will do just that.

We'll use metal rods to hold your spine straight

and bone grafts to fuse the vertebrae.

Once it's fused, your spine will never curve again.

It's a very successful technique.

We do it all the time.

Really? And, uh, when do I get to Penn State?

After about a year of P.T.

Now, the recovery is intense,

but once you're through, I mean,

you'll be done with all of the major issues

associated with VACTERL.

Right.

I don't know. Will I, though?

Kind of feels like I'll never be done with this, Dr. Watson.

I know it feels that way, Kyren, but you're almost there.

And I promise you, you will be done.

- Now, remember, I don't... - Yeah, yeah, yeah.

You don't make promises you can't keep. I know.

All done.

It's been a long road, but it's official.

You're cleared for college.

Oh, my gosh.

-Yes? -Yes. Yes.

Finally. Wow.

Mom, orientation's next week.

We got to choose our teams

and get into our rover designs for the challenge.

Now, make sure that you stick to the diet

-that Dr. Croft designed for you. -Yeah, yeah.

And don't be a stranger, okay?

Yeah.

Oh, man, it is so crazy to think

I'm not gonna be seeing you

in a couple weeks for a check-up.

Well, you're at the finish line now, Kyren.

The most serious challenges of the VACTERL are behind you.

Mm.

Thank you for everything you've done,

- Dr. Watson. Thank you. - Of course.

Come on, Mom, don't get mushy.

- You're gonna give him the ick. - Sorry.

Bless you.

Thank...

- Ah. - Kyren?

- Ah, my back. - Kyren.

- Kyren, what's happening? What's happening? - My back. My back, it hurts.

Shinwell!

What's wrong with his back?

- What's happening? - What's happening?

It looks like one of your rods broke

and is tenting your skin.

We need to get a gurney for Kyren.