Alright. So this this is a story I've been wanting to tackle for quite a while, but always chickened out when I started it. Finally, my friends convinced me to go for it, and I'm having one of them beta for me because I want this to be completed with the utmost quality I can manage, due to its intense nature and deep exploration of the fma universe. This is going to cover everything from human transmutation to state certification.

As an author, I am not typically known for disturbing imagery, but this story will contain a fair share. As such, I want to be clear right here that there will be more mature content in this story than my readers are accustomed to. Of course, none of this is to scare you away; fma is just a darker franchise than my other fandoms.

So anyway, some warnings for this chapter (and story as a whole) include descriptive gore and medical procedures, and some language.

Oh yeah, and this would be a deadly drinking game for the word "blood" XD

With that out of the way, I sincerely hope you enjoy this story, as it's my most ambitious endeavor yet! Let's get started :D

(Update 8/26/22: edited chapter to improve flow and cohesion)

(Update 2/20/23: fixed dashes and hyphens)

(Update 4/25)23: man i just can't leave this one alone. did some more edits to improve story)

(Update 8/7/23: i swear the edits will stop someday...but for now enjoy this update of every single freaking chapter, now with new and improved research accuracy and flow)

(Update 9/24/24: going through yet again and revamping each chapter...and hoping to make actual progress very soon *wink wink* But for now, this one has become a whole new chapter since its first iteration)

Ch 1: At the Brink

When Winry comes home alone from the market, Pinako thinks nothing of it.

The eleven-year-old sets several paper grocery bags on the table, including the two Edward and Alphonse had shoved into her hands. "Ed and Al said they'd be here for dinner, but they had something they had to do at their house first. And Ed said they'll have a surprise for us when they get here," Winry says matter of factly as she begins pulling vegetables out of the bags.

"Did he now?" Pinako asks, inspecting the proffered vegetables. "If it's another weird transmutation, I'm going to throw it in the fire." She chuckles; the Elrics have made a name for themselves giving her...unique alchemy-made gifts. Pinako moves to join Winry with unbagging the groceries. "I'm making the boys' favorite stew tonight. Care to help when it's time?"

"Of course." After half an hour of playing fetch with Den, Pinako calls Winry back inside to start dinner.

The grandmother and granddaughter work on the stew, and in an hour, it's ready. Pinako has poured as much milk as possible into the pot; it's the only way she can get Edward to consume it, and the best part is, he has no idea how much she uses. If he knew...he'd never eat another spoonful. Pinako finds herself chuckling again as she fills Winry's bowl.

"Shouldn't we wait for Ed and Al?" Winry asks when Pinako serves her.

"Those boys will be along. Eat up while it's hot, girl."

Winry can't argue with this. The Rockbells have eaten many a dinner without the boys, but late as they may be, they're always reliable in the end. Winry devours her stew, and halfway through, Pinako joins her. They finish up and wash their dishes, with still no sign of the Elrics.

"Where do you think they are?" Winry asks, brows furrowing in concern.

"You know Ed and Al. They probably got caught up reading again and didn't even see the sun set."

Winry hums noncommittally, not quite convinced but unwilling to contradict her grandmother. She goes upstairs to get her book, and when she comes back downstairs, Granny is sitting in her favorite rocker, her own book in one hand and pipe in the other, Den curled up at her feet.

Suddenly, the dog bolts upright, whimpering.

"Whatsa matter, Den?" Pinako pokes the dog with her foot. But Den continues whimpering, sounding more and more mournful with each breath. "Take her outside, Winry."

Winry does, confused as to what could have spooked her so bad. Den never whimpers like that...but as Winry looks in the direction of her friends' home, she shudders. It looks like it's about to rain, electricity almost palpable in the air. Another, stronger shudder runs through her body, and Den yelps as if in pain. Winry can't explain why...but for no particular reason...it feels like something terrible is happening right at this moment. She forcibly shuts the door, leaving Den still whining outside.

Then, disturbed, she decides to abandon reading and go to bed. She puts on her pajamas and brushes her teeth, before returning to the main level to get a glass of water. "I'm going to go to bed, Grandma. Tell those stupid Elric brothers not to be so late next time."

Winry goes into the kitchen and turns on the tap, grabbing a glass from the cabinet.

Bang! Bang! Bang!

Winry startles, the glass crashing to the floor and scattering shards at her feet. Who would be banging at the door like a maniac at this time of night?

"Granny! Granny! Help!"

Apparently, Al would. A hysterical Al, yes, but definitely Al.

Pinako answers the door, and Winry hears the thump of the book she was reading hit the floor, followed by a gasp. Winry rushes into the main room, seeing her grandmother staring wide-eyed at the door. The girl turns to look for herself…

...and a scream catches in her throat.

There's a massive suit of armor on the front stoop, but that's not what's scariest. It's what it's holding: clutched in the armor's grasp is Edward, devoid of color and soaked in blood.

"Please. Help him. He's gonna bleed to death."

It's Al's voice again. But where is he? His words sound echoey, almost like he's inside the armor. But that's impossible; Al is ten years old, and far too small to be in there.

"Please!"

"Al…?" Winry asks quietly. The armor reacts violently to her mentioning of the name, sputtering and whining. It's definitely him...but how?

Breaking out of her shock, Pinako rushes forward, ushering Al inside. The armor shoves its way in, nearly breaking the doorframe in its panic, and the Rockbells finally get a glimpse at the source of all the blood. Ed's right arm and left leg are gone. Not there. Missing.

Pinako curses, ordering Al (the armor really is Alphonse, isn't it?) to put Ed on the table. It's nowhere near ideal, but if they don't do something this second, he's going to bleed out.

...If he's not already dead.

Pinako pushes that thought away.

"Winry! Go get Surgical ready!" Pinako barks. Winry stands frozen, eyes locked on her bloody friend. "Now, girl! Run!" Tears streaming down her cheeks, the eleven-year-old runs toward the medical side of the house.

Pinako grabs the nearest clean item of clothing, which happens to be her apron, and ties it as a makeshift tourniquet around Ed's chest. She then takes one of her kitchen towels and ties that onto his leg. That should keep until they can finish setting up.

Briefly, she looks at the rattling metal behemoth watching, questioning its presence and relationship to the little ten-year-old. She has so many questions, and no time to ask them. For now, she just has to trust that this…thing really is her beloved Al, and ask questions later. Ed's life literally depends on it. "Alphonse, pick up your brother and follow me!"

The suit of armor does as told, clumsily scooping the older boy into its arms as they rush to the surgical suite. Pinako tells Al to put Ed on the bed inside, while Winry is rushing around, powering on monitors and placing tools within reach with tears continuing to stream down her cheeks. Once Ed is out of his grasp, Al begins screaming inconsolably—begging them to save his brother, his words growing more and more hysterical with each passing second. Winry tries to calm him down, saying they're going to help, they won't let Ed die, but her voice is just as hysterical as Al's and isn't helping. In the chaos, Winry rams into the armor, sending it toppling backwards. Its head flies off, revealing nothing—for God's sake, nothing!—inside. Winry screams, and Al screams, and Pinako looks at them and nearly keels over right there. She forces down her terror with Alphonse's apparent absence and orders him out of the room, all while he's sobbing with no body in sight.

What is happening?

"Winry!" Pinako forces herself to focus back on Edward. "I need your help, girl!" Pinako puts her fingers to Ed's neck, feeling for a pulse. It's there, and she's honestly surprised. "We've gotta stop the bleeding. He's alive, but I don't know how much more his body can take." Winry, still sobbing, nods and starts putting together an IV. Pinako unties her makeshift tourniquet on Ed's shoulder, seeing a basic gauze bandage underneath, wrapped over his shirt and entirely soaked through with blood. She grits her teeth and removes it, then the ruined clothing underneath.

His shoulder is an absolute mess. She can see each muscle, tendon, and nerve around his shoulder socket, uneven and torn at odd angles. Severed vessels are still trying to pump blood to an arm that's no longer there, and she can see the muscle twitching as his nerves try desperately to communicate. The bones that make up his shoulder—scapula, acromion, clavicle—are all perfectly in place, as if his humerus was simply ripped out and everything else left untouched. She's never seen anything like it. Not even war injuries or farming accidents looked this bad, this wrong. She can't explain it, but there's just something so…unnatural and unnerving about this whole situation. Alphonse aside (she can't even begin to wrap her mind around him), Edward's condition just feels so…unexplainable. Like whatever happened, it's not something she wants to know about.

Shuddering, she takes a bottle of distilled water, flushing out any dirt and particles she sees in the wound. Then, she flushes it with a water-antiseptic mix. There's undoubtedly things she's missing, but she doesn't have any time to worry about that right now. The fluid is making the blood flow worse, washing away any clots that had a chance to form. They need to stop it, before he runs out entirely. She grabs the apron again, holding it tightly against his shoulder as she wracks her brain for the best solution.

As she's thinking, Ed's face twitches, and his eyes open a sliver. The golden slits catch sight of Pinako and he makes a noise deep in his throat, but with his body in complete shock, he can't really comprehend anything around him. The hint of consciousness startles Pinako, however, and she has to force herself to remain calm, for his sake. She does not want him awake for any of this.

"It's okay, Edward, it's okay," she says as soothingly as she can. Luckily, or maybe unluckily, he doesn't seem to be responsive. His eyes open wider and his hand clenches shut, reacting to his physical distress, but his mind can't catch up to all the sensations assaulting it. He tries to reach for the sources of his pain, but Pinako catches his hand, holding it firmly but supportively. "No, no, don't touch." Another garbled noise escapes Ed's throat, his eyes almost bulging. He doesn't entirely lose consciousness though, and Pinako makes a mental note to inject an anesthetic into him the moment the IV is complete; no one deserves to be awake during something like this.

She yells for Winry to fetch their special blood clotting powder. It's not an ideal choice, but Ed has lost far too much already, and she wants the bleeding to stop now. Once she has it, she dumps it over the wound. There's so much blood, soaking into the mattress and in his clothes and hair, and who knows how much he lost on the trip over. The Rockbells have never had to do transfusion before, and although Pinako has the equipment for emergencies, she doesn't want her first time completing the procedure to be in such a dire situation. She prays he can make it without one, but knows that hope is unrealistic.

"Is…is he awake?" Winry asks as she inserts the IV needle into Ed's elbow, observing the small distressed sounds and movements coming from her friend.

"Not for long," Pinako answers brusquely.

Winry's lip trembles, knowing her grandmother plans to knock Edward out before he can even attempt to regain full consciousness. It's sensible, in reality, but her heart still hurts immensely with the thought.

Pinako moves to Ed's leg, finding another gauze wrap soaked through. His leg looks much the same as his shoulder; femur, muscle, nerves, all perfectly aligned until they simply cease to exist. The edge is almost jagged, as if something hacked away at it like a butcher carving meat until it got what it wanted. How did this happen? Pinako cleans out and dumps more powder over this wound too.

While the powder does its job, Pinako checks on Winry's progress. She has Ed hooked up to two IV bags, one with fluids and the other with drugs, and is working on taking his temperature. Pinako injects a dose of general anesthetic directly into the IV catheter, hoping to put him to sleep as quickly as possible.

"What's the read?" she asks her granddaughter, who is holding the thermometer with a frightened expression.

"95.8," Winry answers.

That's not good; he's not getting enough oxygen through his blood to stay warm. Pinako looks at his face, his lips and eyelids faintly blue; it wasn't like that when they first laid him down, and that's not a good sign. "Get him on some oxygen." Winry starts work on this, and Pinako goes back to his shoulder. The powder has stopped most of the bleeding with forcible clotting, and there don't appear to be any other noticeable contaminants inside. Luckily, it also looks like there's enough skin left to get it closed, unlike on his leg. She ties off his nerves and blood vessels, then begins the process of suturing. "Okay, Winry, I'm going to put a few guide stitches in, and I need you to take care of his shoulder." Winry makes a small sound, a prepared oxygen mask hovering over Ed's face. "You can do it, girl. You've helped me with plenty of patients."

"But—but...Ed…" Winry whimpers. Edward isn't just some patient. He's her friend, and she can't imagine working on him. "I—I can't…"

"I know it's Ed, Winry, and believe me, I don't like it either. But you want to help him, don't you?" Winry nods. "Then come over here and stitch him up."

After taking a few gulping breaths, Winry places the mask, changes her gloves, and starts working on Ed's shoulder, and that's when Pinako knows the girl is going to be a master engineer and surgeon someday. If she can push through her emotions and operate on one of her best friends, she can do anything.

Pinako moves to Ed's leg. This is going to be harder; there's nothing she can use to close this wound without getting it from somewhere else, not to mention the fact that the way the bone has been severed has very likely been letting blood mix with marrow. She doesn't even want to consider the kind of effects that might have in the future, so she decides to focus on the present. She's going to have to take a graft from his right leg if there's any hope of getting the wound closed.

About halfway into their operation, Edward's body goes completely into shock. Pinako notices the first signs of seizure, and tells Winry to stop her work so they can focus on keeping him safe.

"What's wrong with him?" Winry asks, sounding faint.

"Seizure," Pinako replies, and Winry pales further. She knows all about shock-induced seizures, but has never seen it before. He's not conscious (and hasn't been since Pinako gave him the anesthetic), but his eyes are open and pupils constricted, saliva drooling from his mouth. She thought seizures always came with convulsions, but Ed is almost entirely still, with just his fingers occasionally twitching. Pinako carefully turns him toward the left, to lower the risk of him choking on his own tongue or saliva. She holds his hand, watching for the tension in his muscles to release. It only lasts for forty seconds, but when it's over, things go from bad to worse. His already heightened, erratic breathing grows more and more arrhythmic, until it's clear he's literally fighting for air. And the more deprived of oxygen he gets, the more his brain loses its ability to send out the right signals. It's like his diaphragm can't contract nor his lungs inflate properly. Pinako's heart sinks as his already sallow complexion grows completely blue with lack of oxygen, and she fears he might not be breathing for much longer. "Winry, you're going to have to intubate him," she says, feeling numb. "I have too much open wound over here to stop stitching."

Winry just stares for a moment, and Pinako feels indescribable grief for putting all this on such a young girl. But the truth is, she just can't do it alone; she needs Winry's help if there's any hope of saving Ed's life.

"I..." For a moment, Winry looks like she's about to faint, her face almost as pale as her friend's. But then she nods, and with trembling hands, she forces their smallest endotracheal tubing through the oxygen mask and down Ed's throat to open his airway. "It's okay, Ed, it's okay, it'll be okay. Breathe…please…please…" she chokes out, more to herself than her friend. She checks his pulse, terrified there won't be anything. There is, and her eyes flutter shut, knees nearly giving out as she feels the weak beat beneath her fingers. She's never seen anyone look so dead and still be alive; he's completely drained of all color, unmoving, and cool to the touch. If she couldn't feel his pulse with her own fingers, she wouldn't believe he was still there. As much as it terrifies her, she knows if he'd gotten here even a minute later, he would be dead.

Pinako is horrified as well. She gives herself a moment to watch Ed's chest rise and fall—knowing that as erratic as it may be, he's at least breathing—before forcing herself to focus back on her operation. "Let's finish this fast, Winry, I don't know how much more stress he can take." Somehow Pinako keeps her voice steady, even though she's entirely terrified at the thought of losing Ed. She swallows her fear; even if he doesn't make it, she can't let it be because she didn't try her damndest to save him.

Pinako works quickly to get his leg finished, and then prepares the supplies for blood transfusion. She checks his blood pressure, a sinking feeling in her stomach. He's just lost too much blood; she'll have to go through with the procedure if he has any chance of making it through the night. She feeds a second, bigger needle into his arm, setting up a steady flow of donor blood while Winry finishes up cleaning his wounds.

Three hours after the Elrics' arrival, the Rockbells finish their operations.

Finally able to breathe again, Pinako checks the IVs, pleased with what Winry put in. Painkillers, sedatives, fluids...even in her panic she knew just what to do. She checks his breathing tube, retakes his temperature, and thoroughly examines him for any other injuries. She's dumbfounded; apart from the missing limbs, there's not a scratch on him. How could someone have two limbs cut off and be entirely uninjured anywhere else? How did this happen?

"Grandma?"

Pinako looks over at Winry. Adrenaline settled, the girl looks much too young to have done what she just did…she is too young. Her eyes locked onto her cold, still friend, she bunches up fistfuls of her surgical apron, splattered with far too much blood.

"Is Ed going to die?" she whispers, trembling slightly.

Pinako doesn't know how to answer that. There's a very real possibility he won't make it through the night if he doesn't stabilize soon. But instead, she chooses to give Winry the "child's answer". "Of course not." She knows Winry is too smart to accept that at face value; the eleven-year-old knows more about the practice of medicine than most adults. But even so, Pinako sees a small flicker of relief in the girl's eyes.

"Yeah. He...he can't die." She shifts uncomfortably. "What about Al?"

Pinako almost forgot about that behemoth armor. She doesn't want to leave Ed, but she really should go find the other Elric brother and make sure he's okay. "I'm not sure, Winry. Stay here, and yell if anything changes with Ed."

Pinako sheds her bloodstained apron, leaving Surgical and going back into the main house. She walks upstairs, seeing the door to the room the boys share is closed. She knocks softly. "Alphonse, I'm coming in."

The suit of armor is sitting on the floor by Edward's bed, facing a small toy on the pillow. Pinako recognizes it from when the boys were just learning alchemy, and Al made a terrifying stuffed animal, a cross between half sheep and half rack of lamb chops. The Elrics soon turned that malformed toy into a tradition, trying to out-prank each other with alchemy, and the infamous mutant sheep became the symbol of their progress.

"Alphonse?" Pinako approaches carefully. She's not exactly sure what to make of the boy, and that includes what he's capable of. She's still not entirely sure it's even Alphonse, and that thought scares her.

"I put the sheep on his pillow this morning," Al's voice says, and it slightly relieves her; only Al would know about that tradition.

"Al…"

"I'm so sorry, Granny."

Pinako takes a deep breath, the question feeling heavy on her tongue, but entirely necessary. "What did you two do?"

Al whimpers, turning the armor's helmet away.

"Alphonse. What happened that put the two of you in such states?"

"We...we didn't mean it," Al whispers. His words sound like he's crying, but Pinako isn't sure how. "We just...just wanted to see Mom again."

Pinako's gut freezes. "Al…" she begins, tone deadly serious. "Did you try to bring your mother back to life?"

Al's crying noise continues.

"Alphonse Elric, did you try to resurrect Trisha?"

"Y-yes."

Pinako's hands curl into fists. She knows next to nothing about alchemy, but everyone, no matter how inept in the field, knows what human transmutation is. It's forbidden amongst alchemists, because the nature of messing with human life is considered evil, even to them. And now, her own adoptive grandsons have attempted it.

"What happened?" Pinako demands.

"We—we've been planning it for years. And we thought… today would be the day. But it went wrong. It went so wrong, Granny…"

"What happened to you, Alphonse?"

"I don't know exactly...we touched the circle, but it just felt wrong and then everything started flashing and these little hands came out and grabbed us. I tried to get to Brother but it was like I was being torn apart. Then I woke up in this armor. I...I don't know where my body went…"

"So you're really empty then…" The words sound unbelievable coming out of Pinako's mouth, even though she saw the proof herself earlier in Surgical. She looks the younger Elric over, brain not willing to comprehend what her eyes are seeing.

"When I woke up, Brother was on the floor, and he was bleeding really bad. He said something about a trade, then he passed out. I didn't know what to do, so I found some bandages and came here."

"Your brother is missing an arm and a leg, Alphonse."

"I—I know…" The crying noise starts again. "Is he gonna die? Please, tell me he's not gonna die…"

"He made it through the worst of it," she replies, even though she honestly doesn't know. But she doesn't think any of them could handle thinking about the alternative right now.

"I don't know what to do, Granny."

"I don't know either, Al. You two really messed up, didn't you? But…" Pinako hesitates a moment before putting a hand on the cold metal armor. It sends a chill down her spine, and she fights the urge to pull away. "I'm glad you're alive."

"Am I alive? I can't even tell anymore…" Al says meekly. He shifts, holding his hands out, and even though she can't be sure, Pinako is pretty certain he's looking at them. "I can't feel anything. I can just hear and see, and it's so late but I'm not even tired or hungry at all. I—I'm really scared."

"Yes, Al, I'm positive you're alive." Is she so positive? "I'm talking to you, ain't I?"

"I'm just so confused…"

"We'll figure it out together, don't you worry." Despite him saying he can't feel, Pinako rubs her hand up and down his arm. "I need to go now, Al, and check on your brother. Will you be okay?" The armor nods after a moment. "Okay. I'll have Winry come check on you too, alright?"

Pinako shuts the door behind her, making her way back to Surgical, where Winry is curled up on the floor, watching over a half-dead eleven-year-old.

"I think he's stabilizing," she says, wrapping her arms around herself. "His temperature is up, and blood pressure is improving. But I listened to his breathing and it's still really erratic, so I kept the tube in."

"Okay. Well keep him intubated overnight just to be safe, and then we'll...fully instate him. I don't want to risk it tonight," Pinako replies, gently rubbing Winry's back. She's more proud of the girl than she'll ever know.

Winry says nothing else; she's emotionally and physically exhausted. She stands, wavering for a moment as dull blue eyes look over her mutilated friend, lingering on the pair of bloodstained bandages.

"I'm going to stay and watch him until I'm sure he's stable. Alphonse is upstairs in his room, and I think he'd appreciate seeing you. And then go on to sleep, Winry. We've done all we can for now."

Winry doesn't want to leave, but she's just too tired. She hugs her grandmother, then heads out the door with dragging feet.

Pinako looks back at Edward, at all the tubes and bandages and machines. He doesn't even look like himself; missing limbs aside, there's just something too alien about the situation that she can barely bring herself to believe the boy in the bed is the same one she sent off to the market this afternoon. It still doesn't feel real, but it is, and she has to do everything she can to help him. She watches the slow rise and fall of his chest, and listens to the tune of machinery all throughout the night.

And there's our start! I suppose I should mention that this story is BH/manga compliant but does take bits and pieces from 2003 as well.

I hope you all enjoyed the first chapter, and will join me for the next one!

~PrinRue

(Note 9/24/24: This story now technically has 6 companion chapters, all found in "31 Ways to Whump"! See chapters 2, 6, 21, 25, 26, and 30 for more of this timeline ;D)