On September 4th, 1998, Abraham Elliot Walsh was born in the bathtub of his mother's tiny apartment. His mother, Lisa, had been excited for his birth, but once he's born she realizes she isn't able to provide him with the life he deserves. Desperate, she tries to abandon Abe, but is convinced into keeping him by her elderly neighbor, Ruth.
Ruth helps Lisa raise Abe until he turns 7, when Ruth becomes ill. She dies painlessly in her sleep, leaving Lisa and Abe alone. One day, Abe wakes up alone, waiting for almost two days before he goes down to the apartment manager and saying his mom was missing. Abe is put into foster care until age 10, when he's adopted by Deborah and Alan Reynolds. Abe is excited for the prospect of having a family again, but he soon realizes the Reynolds' aren't quite what they seem. He finds solace in the Reynolds' other foster child, Maggie. The big brother role he fills feels natural, the two of them inseparable.
Now that Maggie is 18, she's legally able to get away from her family, the two of them finally free from the monsters that were supposed to raise them. Abe takes her with him to Pittsburgh, where he lands an internship at the Pittsburgh Trauma Medical Center.