Alternate ending (kinda bitter sweet)
FiorellaTyrell this is for you
I'm going to pick up from when the nations got to the hospital after the attack
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It had been agonizing for the nations. Germany, Prussia, Italy, Romano, Japan, China, Spain, England, France, Canada, and Russia were being driven mad by the unknown. The worst of the bunch was Canada, he was pacing crazily around the private room where the nations were waiting. He was shaking horribly, scared shitless that Alfred was going to die. If Canada wasn't pacing the room, he was tugging his hair or dress shirt. He bit his lips so much they began to bleed. Nobody could convince him to relax.

They want me to relax? After all this? I can't relax! Not until I know my baby brother will be ok! God, what have I done! I should never had pulled that prank on him! What if he dies?! What if I never get to tell him how sorry I am?! Maple, I don't know how much longer I can last, eh!

A nurse came into the room with a bunch of blankets for the nations, each one covering themselves and doing their best to rest. Matthew curled up on the windowsill, curled up and quivering. He didn't want to sleep until he held his brother in his arms. He stared at the moon for what felt like eternity before he heard the door creek open. The blonde turned his body and saw a man wearing scrubs looking around. Matthew shot up and ran to him.

"Is Alfred ok?" he asked worriedly. His volume was low, he didn't want to wake everyone else. The doctor could see the panic and regret in Matthew's eyes.

"He'll make it. His heart gave out a few times though, we had to defibrillate him five times. He's currently stable physically. However, mentally, we cannot be certain until he reacts to someone from his past," the doctor explained. Canada nodded as the doctor led him to Alfred's room: 143. Canada laughed dryly at the irony, 143 normally means I love you. The doctor opened the door and left the brothers alone. Matthew ran up and gently hugged Alfred. He kissed his brother's temple repeatedly, but Alfred remained still.

"Alfie? Can you feel me? Can you hear me?" Canada asked, gently tilting America's head. He gasped and his eyes widened with horror when he saw Alfred up close: Alfred's smile didn't even exist, his cheeks were sunken in like he hadn't eaten in months, he was paler than snow, his body seemed extremely cold, his hair was dull, and his eyes were completely lifeless, "A-Alfred... I'm so sorry... I'm sorry I did this to you..." Canada whispered as he laid his forehead in the crook of Alfred's neck. Alfred still didn't respond, it was as if he was numb to his brother's presence. Just then, the other nations came in. They looked upon the scene with horror. Alfred blinked slowly, but still didn't move.

"America, lad?" England approached him and gently grazed his cheek. He retracted his hand once he felt how cold and skinny his face was. The nations looked over him, head to toe. They saw it now: the thin frame of an anorexic or bulimic boy, the tired way he sat, the paleness of his body, how silent and meek he was, and how empty his once shining eyes were. Alfred was like this for such a long time, but he never told them. Alfred blinked slowly again.

"Fredka, you are feeling better, da?" Russia asked nervously. He didn't like this, he didn't like it when America was still and silent. America didn't respond.

"America, aru. Does anything hurt?" China questioned. He was met with silence again. The nations thought that maybe he had gone deaf or blind, but that idea was dashed when a nurse came in to give him pain medicine.

"America, how are you feeling?" The nurse asked softly as she pet his head.

"My back hurts and I have a headache. Can I have some food?" Alfred asked, his voice soft. The nurse gave Alfred the medicine and nodded.

"I will be back with some ice chips," the nurse walked out. The nations were stunned when America turned his body and got up, talking the pole and walking to the toilet. After he was done in the bathroom, he washed his hands, came back out, sat on his bed, and turned away from his once comrades. The nations got the message and left in tears, except for Matthew. He refused to leave his side.

Months passed, America no longer attended meetings. He just sent in his reports or if he was feeling good he would send a video of him presenting. Matthew kept attempting to apologize, many nations did. But Alfred ignores them, he never tried to contact them. He instead spent time with his pets and picked up a few hobbies. All the nations still followed him on social media, they saw how Alfred changed. His instagram no longer had selfies of him, it was mostly nature pictures or ones of places or pets.

The nations hadn't seen America in a year when he finally reappeared. He didn't mean to reveal himself, it just happened. Germany was carrying a bunch of heavy boxes into a UN building and was about to drop one. That's when a mystery man swooped in and saved the package before it hit the ground. Germany turned and saw America, he had changed.

His eyes were bright again, his Nantucket was perky, and while he was straightening out he saw Alfred's smile. He had been working out, he was almost as muscular as Germany was. He was wearing dark jeans, brown leather shoes, a brown belt, and a white and blue thin striped dress shirt. The top three buttons were undone, showing off his pecs. The sleeves only went half way down his arm, showing that Alfred had gotten a tattoo of a semicolon on his wrist. It also helped accentuate how muscular Alfred's arms had become.

"Here you g-" Alfred paused when he saw it was Ludwig. The two stared at each other and Alfred's smile dropped. He quickly gulped down his voice and put the package back on the stack. He bowed slightly and walked off politely. Germany dropped the packages immediately and ran up to America, hugging him tightly. This caught America off guard, and they both tumbled to the ground. America was about to yell at the other nation but saw just how Germany changed.

His hair was disheveled, like he didn't even try. His suit was wrinkled and he didn't have a tie on. Germany's eyes were soft and his face was contorted with emotional turmoil. He had lost some weight, not a lot but it was obvious he was smaller. Germany was clutching America shirt and crying into his neck.

"Don't go avay again, Alfred. Don't leave us again. I am begging jou, Alfred. Come back," Germany's voice cracked as he continued to cry. Alfred was stunned, if Germany was this bad he could only imagine how bad everyone else was. America hugged Germany, trying to comfort him.

"I can't forgive you for all that you and the others have done. I never will. But, if I am needed this badly, I will return," America was monotoned, but Ludwig didn't care. He was just happy America would be coming back.

"Everyvon is vaiting on those packages. Vould joy help me, Alfred?" Germany composed himself and smiled softly. America smiled softly back and nodded. Alfred grabbed a few packages and Germany grabbed the rest. They both arrived to the meeting room, and every conversation ceased. Everybody stared at Alfred and he stared right back. Alfred took note of how every nation changed.

Russia seemed to have bags under his eyes and a hangover. He had become an alcoholic.

China's hair was a mess and he was jittery. He saw how the ancient scratched his arms nervously and had the indent of a lighter in his breast pocket. Drug addiction.

Japan was playing on his phone, like the world no longer existed. He didn't speak, it was clear he didn't want to be there. Kiki had isolated himself again.

Spain was tired and had puffy eyes. He was shaking horribly and was messing with a rubber band around his scarred wrist. The once happy Spain self-harmed.

Italy and Romano had deep bags under their eyes, with mountains of paper work. Both of them looked like they had eaten in weeks. They were depressed.

England looked composed, but he also had deep bags under his eyes. He took note of how detailed and long his speech was, with different annotations and different color highlighters. His Iggy had become a workaholic.

Canada was dangerously thin. He looked like he had been through hell and back. He didn't have a packed lunch and judging by how boney he was, Alfred knew he had become anorexic or bulimic.

France lost a lot of weight and seemed so tired. Alfred figured it was because it was France's attack that landed him in the hospital in the first place. He had a combination of the symptoms found in the others.

He felt so selfish upon seeing everybody's state. He walked to the seat between France and Canada, sitting down. Alfred heard silent whimpers coming from France. Alfred turned his and France's chair, embracing him tightly.

"Amerique... Big Brother is sorry..." Francis weeped as he clutched America's shirt. America rubbed the elder nations back softly. He heard sniffing coming from his other side and gazed at Canada, who was silently crying into his polar bear. America kissed France's head and opened his arm to Canada, who jumped into Alfred's warm embrace.

"Guys, I'm here now. I'll help all of you get better again. I promise," Alfred smiled at the small, sad crowd. All of them pounced onto America, tightly embracing him. Japan especially was one to attach himself. America decided to lead the meeting, considering Germany barely kept his composure. The group listened carefully to their returned angel. America did stick to his word.

He helped China beat his opium addiction.
He helped wing Russia off the bottle.
He helped Japan become social again.
He stopped Spain from harming himself.
He nursed the Italies back to happy spirits.
He showed England hobbies so he didn't overwork.
He cured Canada of his bulimia and got him to laugh a lot more.
He lifted France up and got him to be the suave dimwit big brother he always loved.

Though he never forgave them for what they did to him, he was the hero. He still loved their company and wanted what was best for him and them. After he came back, many nations changed towards him. The only two nations who still insulted him were Afghanistan and Syria, but ironically Iran and Iraq always silenced them.

The nations learned a valuable lesson: you never know what you have until it is gone.