Alfred's first sign was the nausea and sickness. He was constantly pale and sweating; the last time he was this bad the Civil War started. It struck randomly, sometimes at home, other times in public. Al did his best to hide his condition from his fellow personifications; they knew as well as he did that a country was unbalanced and weak when a new leader came to power. But he knew that whatever it was that was affecting him was new, worse.
Things came to a head at their semi-annual meeting. Alfred was pale, shaking. He hadn't opened his mouth in fear of vomiting what little was in his stomach up. In his inattentiveness, he didn't notice when the room became quiet. He didn't notice when his fellow personifications started staring at him, studying him. He didn't notice England's approach, genuine worry on his face. England gently touched his shoulder, and America snapped out of the trance he seemed to be in.
"America, are you feeling alright?" England hesitantly asked.
Al tried to laugh, but it came out more as more of a choked huff before he felt the bile rising from his stomach. He barely made it to the trash basket before his stomach heaved to expel that morning's breakfast. Bent over as he was, he didn't see the looks of worry exchanged behind his back. He didn't stop heaving until minutes later, his stomach long since empty, and his eyes showing a weariness that England had long since thought he'd figured out how to hide. Alfred's eyes lowered to the mess he had made in the trash, his weary mind only just processing the presence of blood in the stomach acids.
"That's new." Alfred muttered to himself, so out of it that he didn't even try to keep the other nations from hearing him. Distantly, he heard a gasp, and a whispered, "This has happened before?" Alfred looked up once more, finally realizing that he was not alone. He absently wiped at his mouth with a tissue he pulled out of who-knows-where, moving with motions so smooth that you could tell he had experience with cleaning himself up after something like that, even when his hands were still slightly shaking.
Alfred knew that if something was wrong with him, something was wrong with his country. He had a feeling that it would only get worse, and he was scared of what might happen to him. Would he just…. Cease to exist to be mostly forgotten by the countries of tomorrow, like Native America had been, like Germania had been? That scared Alfred, to what extent he didn't know. Alternately, he might just… Die. Like Rome, like Romano had done several decades ago. Alfred's thoughts froze at the name. Ro-romano? Who was…? Al pushed the thought away to focus on the relevant things and thoughts, and the questions of, How will I explain this?, and What will they do with the information if I decide to share? Hey, Al was probably dying, indicating that America itself was weakening and deteriorating enough that if his health was being affected at such a rate chances were that the country really was on the verge of collapse, so he was allowed to be a little freaked out, okay?!
"Hey, America, are you alright?" Alfred almost glared incredulously at England.
"I just puked out blood. Are you sure that's what you should be asking?!" He said. England almost blushed in embarrassment, but held himself back. "America, seriously, mate. You've clearly been sick for a while, why haven't you said anything?"
Alfred snorted. "Are you kidding? More than half of you," he gestured with a hand, "think I'm an immature little kid, a lot of you don't even like me, and certain others would see me dead. What good would it do?" He covered his mouth with his handkerchief again as he coughed once. He continued on in a low voice as he talked directly to England. "Besides, you of all countries should be glad that karma's come back to bite me in the ass for everything I've done over these four centuries, in the worst way possible."
England paled. "You're dying?!" He exclaimed.
"Shhh! Keep your goddamn voice down, you fucking idjit." Raising his voice to where the other countries could hear, he said, "And I'm not dying! This latest election just has me feeling worse than usual, is all."
"That's too bad." A new voice sounded out. Alfred mentally groaned. Great… Russia. "It vould benefit Mother Russia greatly if you vere to keel over, da?"
Alfred groaned audibly this time. "For the last time, you fucking Red, I am not going to be joining you!" America sighed before calmly standing and going back to his seat. "I'm fine," he repeated. "This election just has myself and my people divided. Though, luckily, not in as… literal a sense as the Civil War did, it's still draining and disorienting." He felt like he was going to start rambling, but luckily an exclamation from France interrupted him.
"What do you mean, 'not in as literal a sense,' America?! Surely you don't mean…"
Alfred nodded. "I do. Any of you who've had a civil war in your country know that the other side becomes something of a split personality, right?" France, England, Japan, and multiple other countries nodded, all wondering where he was going with this. "Well, with my civil war… It wasn't like that. The Confederacy… when those states split from me… He did too. The Confederacy, I mean." Alfred started at the table, eyes tracing the wood grain as his voice waxed sad, and melancholic. "We could have been, we were brothers…. Twins, even, we looked so alike. But his colouring was all wrong. Where I was the sandy blond of New Jersey, he was the Dark brown of freshly tilled soil. Where I have blue eyes to watch birds fly, he had red eyes to watch blood flow." He ran a hand down his face, as if reminding himself that he was America, not the confederacy. "He was everything I hated about myself, but he was still my brother, for fucks sake!" And I- I still had to- I killed-" Canada hugged Alfred, making soft shush-ing noises as he shielded his brother as best he could when he started breaking down, tears streaming down Alfred's stricken face.
"I think we should call this a day, non?" Canada said, knowing that, for once, everyone could see and hear him before he started speaking his Father's tongue.