IMPORTANT A/N PLS READ

For as long as I can remember, I have been fascinated by the medical field. I was telling people I wanted to be pediatric nurse when I was five years old. I started college as a nursing major, and the only reason I switched to English is that my school is super selective in choosing who gets into the nursing program junior year, and starting college during 2020 kind of screwed my chemistry grade. I. Love. Medicine.

And across all of the fics I've read that deal with this part of the timeline, I've never read one that actually details automail surgery. Like, REALLY talks about it. So, after consulting with my beta, she encouraged me to go for it.

But, as I was writing, I started making little diagrams and other bits of art to help myself write, and before I knew it, I was writing an entire pseudo thesis alongside this fic. And, I knew I had to share it with you, not only because of the hours spent, but because it's very helpful in understanding this chapter and the ones to come. That's actually why I haven't posted this chap for so long... because I was getting all of the automail stuff put together so I could post it with this chapter.

Now, none of this is to scare away my readers. While I DID go in depth into the medical side of FMA, there is still plenty of the character interactions and emotions you've likely come to associate with my fics. I just got to explore another one of my interests alongside it.

So, without further ado, here is the link to the accompanying post. I linked the table of contents so you can reach any section of it. I really hope you give it a look, I worked a long time on it :D

prinrue

. tumblr

. com

/post/689715551425232896/the-mechanics-of-automail

Thank you all for your continued support, and enjoy chapter 13! Warnings for graphic content.

(update 12/23/22: edited chapter with improvements... a lot of them. Like 600 hundred words extra kind of improvements...)

(update 8/9/23: mass update!)

(update 9/28/24: mass update!)

Ch 13: Remodeling

The day of Edward's automail operation dawns cold and cloudy, with an ominous hint of electricity in the air. The four inhabitants of the house wake with solemn stoicism, and jump into preparations. It's likely going to take the better part of the day to complete the surgery, so there's no time for delay.

Ed has been unusually quiet since he was moved into Surgical, his mind clearly miles away. Winry and Pinako have been bringing tray after tray of supplies into the room, and Ed has watched every trip with stony eyes.

On their fifth trip, Granny asks, "You're sure you won't regret this?"

"My mind is made up," Ed replies. "How long will the surgery and rehabilitation take?" He already knows the answer—it's been drilled into his mind by now—but he just wants her to say something else.

Pinako senses this, and grimly replies, "I'd say about three years, more or less."

Three years...three years. He has way too much to do to spend three years learning how to use automail. Ed thinks for a moment. "I'll do it one."

Winry and Pinako blink, before Pinako breaks into a sly smile.

"You'll have yourself spitting blood, you know that?" the old woman says, getting a slow nod in response.

Ed turns to Al, who hasn't left his side all morning. "Al, just hang in there a little longer, okay? Then we're gonna get you your body back. I promise." Maybe if I say it out loud, it'll come true.

Al nods, and Ed guesses he would be smiling. "Right. And while we're at it, we'll get yours back, too."

Ed offers a small smile, even if the words dig at his insides.

Pinako sighs, setting her last supplies on the table with the rest of the bins. That was his final chance to back out; it's settled now. "Alright, then, Alphonse, time for you to go," she says, nodding at the ten-year-old.

"But I want to stay with Brother," Al says, standing in front of Ed as if his sheer size wasn't enough to make him unmovable.

"I know you do, but this is a very serious surgery, and we can't risk anything making him sick. That includes contact with water towers like you," she teases.

Al sighs softly. "I understand." He turns his attention to Ed. "I'll be right there when it's over, Brother. I promise."

Ed nods again, fighting the urge to cry. "I'll see you then."

Al leaves, and Ed feels an empty pit growing in his stomach. He takes a deep breath.

"Alright, Edward, here's how this is going to work," Pinako starts. "Winry and I are going to sterilize ourselves, then you, then everything you're going to touch. Then, the first phase of surgery is going to happen while you're asleep. That's when we'll carve out where your ports are going. After that, we'll wake you up and do your nerve connections. Then, we'll put you to sleep again and build the support structure."

Ed feels his eyes narrow in disgust as Pinako's words sink in. "How come I have to be awake for the second part?"

"We're working directly with your nervous system, Edward. You have to be conscious to tell us if something goes wrong."

"How would I know if something goes wrong?"

"If at any point you can't feel anything anymore, then that's not good, and we have to stop."

Ed shuts his eyes, bunching up his sheets in his hand. "Okay. I'm ready."

Winry and Granny leave, coming back fifteen minutes later with new clothes and aprons. Pinako removes the bandages from Edward's chest then leaves him to soak in an antiseptic solution in the adjoining lavatory. Then, she and Winry meticulously disinfect all the surfaces in the room, change the sheets on the bed, and double check that all of their instruments are sterile and prepared. Pinako goes to retrieve Ed, wearing latex gloves and a mask. The sight only makes the pit in Ed's stomach deepen; this is really serious. She helps him dress in a new surgical gown, offering a comforting hand when she notices him shaking. Ed catches one last look at himself in the lavatory mirror; he takes in his appearance as it is one last time. Pinako helps him back to the bed and gets an IV in his arm, dripping the fluids he's sure to lose soon. No painkillers yet because they won't wear off in time for the nerve connections, and he can't be experiencing any sort of numbness during that stage. It's barbaric, but necessary. She slides the anesthesia mask over his nose and mouth and tells him to count down from ten.

He doesn't even make it to six.

"Okay, Winry, we're going to have to work together to get this done." Pinako says. "I don't want to keep him under for much longer than our usual patients, but that means we have to work double time to get both ports finished. I want you on his leg, since it's less complex."

Winry shifts, her voice more timid than usual. "But...I've never done a full operation. I've only ever helped…"

"You're ready, girl. Just stick to what I've taught you, and you'll do just fine. I'll be here the whole time to help. I made you co-mechanic, didn't I?"

Winry makes a small noise, but nods nonetheless.

Pinako begins work on Ed's shoulder, making an incision from the tip of his acromion to the space below his shoulder socket. Automail arms are not nearly as common as legs, and automail arms from the shoulder are even more uncommon. Oftentimes, the outfittee winds up needing more bones in their shoulder amputated to fit the port, but Pinako has figured out a way to keep most of his remaining bones intact. The most she has to do is file back the tip of his acromion, to make his shoulder a little more even.

She finds his shoulder socket, digging an inch further into the surrounding muscle. More often than not, shoulder outfittees lose the ball joint to disease after amputation, but Edward is lucky; the bone is still healthy, and will make operating his automail a lot easier since she can work with his natural joint. For a moment, Pinako's mind wanders back to how the hell this happened, but she's still thankful to whatever quirk of alchemy or God or whatever took Ed's limbs that it was kind enough to preserve the pieces it didn't want.

Pinako forces her focus back to the present. This area—the glenoid cavity—is where she'll build small cylindrical caps to hold his nerves. She ties off the stray nerves and tendons and blood vessels around the socket, leaving just the brachial plexus available to receive signals. With the space hollowed out, she moves to check on Winry. The girl has done something similar, only her hole is around his femur, and about half as deep. She wipes some blood from the site, pleased with the minimal amount of bleeding.

"Ready to wake him?" Pinako asks. Winry nods, and Pinako shuts off the flow of anesthesia, giving it a minute before removing the mask. After a few minutes, she sees Ed's breathing begin to quicken, and his features tense up in pain. He fully comes to ten minutes later, eyes wide and panicked. A series of strangled noises escape him, but no words.

"Shh, Ed, you're all right, everything's okay," Pinako says soothingly, because if she didn't say it, he wouldn't believe it. "Winry and I are going to start the second part of surgery, alright?"

The boy whimpers softly, squeezing his eyes shut. "How much...is it gonna...hurt?" he asks between breaths.

Neither Rockbell answers that question.

"Here, Ed. It'll probably help to bite this." Winry holds up a cloth. "And if you need to throw up, just yell. We always have a bucket ready for automail surgery."

Ed looks terrified, but opens his mouth when Winry offers the cloth. Pinako and Winry move back to their assigned limbs.

Pinako splits the nerves she left into their natural branches, twisting each into a tight cord. Then, she inserts the first piece of automail—a tiny metal cylinder that sits at the back of the shoulder socket. She feeds the axillary section of nerves into the cylinder through their natural entryway, while the other two sections are held off to the sides for later.

The main cord of nerves is going to be the central plug in the port. She caps the metal cylinder, sealing off the nerves, then connects it to the amplifiers that will hear his nerve signals and power his automail. She's deep in work on this when Edward's voice cuts into her focus.

A distressed noise escapes him, and he spits out the rag in his mouth, hand scrambling to cover it. "Granny! Granny! Can't—gonna—feel like—"

Winry jumps to Ed's side and pulls him half-upright. He barely gets his head over her bucket before he's puking. Pinako stops her work, whispering comforting words and rubbing his back until he regains control of himself. Vomiting is common during this part of the operation, when the body is basically turned into one giant, raw nerve and every fiber of it is fighting to make sense of what's happening. She also knows it won't be the last time.

Five minutes later, Pinako resumes building his port. She makes plugs for the median and radial sections of nerves, then seals them off above and below his shoulder socket. With his nerves safe, she connects coated internal wires to the caps, ending in the external plugs his arm will eventually connect to.

All the while, Edward's muffled screams and cries cut into the Rockbells' work, threatening their resolve. Hearing such raw, heart-wrenching sound coming from him is near debilitating. At least when he first showed up with two missing limbs, he wasn't aware during their operation. But now, he's trying so hard not to scream and cry, it's heartbreaking. Pinako can see him biting the rag so hard, if it wasn't there, she'd be worried he'd break his teeth. Despite his efforts, a steady stream of tears are running down his face, and his hand is twisted in the sheets, shaking and white-knuckled.

Winry knows she's not making as much progress as her grandmother, but listening to Ed's anguished cries has made it hard to focus. She's never heard her friend make sounds like this before, and it's more than upsetting. She's gotten his nerves into their caps, but hasn't gotten the wound closed, much less finished the wiring.

A moment later, Edward gets another wave of nausea, and spends another five minutes throwing up. When he finally stops, Winry is shaking almost as badly as her patient. "I...I need a moment…" she squeaks out.

"C'mon, Winry, keep going," Pinako says firmly. It's not like she has no sympathy; she understands the girl's feelings. Even if Ed isn't reacting any differently from the dozen other people Winry's worked on, she didn't know their other patients. Still, if she's going to do this for a living, she needs to be able to handle hard situations like this. "I don't want to be in this stage any longer than we have to."

Winry nods, taking a deep breath. "I'm sorry, Ed…"

"Don't...apologize." Ed squeezes his eyes shut, entirely out of breath. "I asked...for this…"

"And you're doing a good job, Sprout," Pinako adds, wiping his face with a damp washcloth. "Now let's keep working, Winry."

Winry goes back to her task, finishing off the outlets in the next ten minutes. She pulls down her surgical mask, lips pursed in scrutiny. "I think I'm ready for the monitor," she says.

"Good. I am too," Pinako replies.

"The what?" Ed asks, craning his neck to look at the Rockbells.

"We've got to hook you up to a monitor to watch your nerves and pulse and blood pressure and stuff," Winry explains. "It would be bad for the Rockbell name if you died on us," she teases (albeit a little shakily), earning a glare from Ed.

"It also serves as a test to make sure the new ports can handle connection, as well as get some fluids and medicine into the wounds to keep them clean," Granny adds. "It's going to hurt, but I need you to lay as still as possible, Ed." Granny rolls over a machine with various wires and switches.

"Do it...I'll be fine," he says, but still can't help but turn his head away as she approaches.

"I'll count to three, and then Winry and I will plug them in." Ed nods, clutching the bed sheets tightly. "One, two, three."

In one movement, Ed feels like he's been struck by lightning. Every nerve (already on fire from being messed with) seizes up at once, stealing the air from his lungs and making his spine turn to stone. He feels it travel from both top and bottom, shooting up his back and all the way into his brain. A broken shriek escapes his throat, and he swears he can feel his blood rushing through his veins.

"Gr-y—Win-!" He chokes on his own words, looking desperately at the Rockbells while his hand claws at the sheets.

"It's okay, Edward, calm down!" Winry pleads, unable to hide the trembling in her voice as it rises in desperation. It's common for patients' fight or flight to be activated during connection, and the Rockbells have had to use restraints on many of them, but it's never an easy situation. It's for the patient's (and doctor's) safety, of course, but it still feels barbaric, and is always a last resort. Winry eyes Ed's hand and foot, before he gains enough self control to dig into his blanket with both fingers and toes rather than kick and claw at it.

"Fire—agh!—why—" His words are nearly indistinguishable now, but both Rockbells catch a multitude of undisguised curses rush from his mouth. Winry's eyes widen to three times their size at the rant, while Pinako chuckles. After a minute, Ed's breathing finally calms, still cycling much too fast, but nowhere near how it had been. He finishes his incoherent statement with a very clear and drawn out "ow".

"Go get him a wet rag, Winry," Pinako says. His bangs are plastered to his face with sweat, coating his visible skin in a light sheen. Winry hurries to the adjacent prep room, and Pinako gives Ed a sly smile. "What your mother would have said if she heard the words that just came out of your mouth." Ed glares at her through his pained grimace. "I told you it would hurt."

"You didn't say...it would hurt that much…" Ed continues glaring; he just had his entire nervous system set on fire and she's joking with him?

"Just hang in there. We have to let the monitors do their job for a while before we continue working on the ports." She spreads a thin blanket over him. It'll be at least an hour before they can continue, so he might as well be comfortable. Well, at least until the fever really sets in...

He pulls the blanket up, looking confused. "Why?"

"To make sure you're stable enough to continue. We won't know for sure how your body is going to handle the automail for about a week, but this stage is when the first signs would show up if you're rejecting it. If your blood pressure drops too much, or if your heart beats too erratically...we'll know something might be wrong." She picks up one of the lines feeding into his shoulder, watching the clear liquid dripping through it. "The medicine will help, but right now, you have two wounds that are very open and very susceptible to bacteria. Any disturbance in your immune system and your body won't be able to handle the foreign metal."

Ed nods slightly. That's why she was joking with me. Because she's nervous, too.

Winry comes back into the room, holding a white rag. "Here, Ed, this'll probably feel nice," she says, setting it over his eyes and forehead. He relaxes a little, humming in confirmation. With that done, Winry turns to Pinako, looking disturbed.

"Something wrong?" the old woman asks.

"Yeah—" Trying to prevent Ed from overhearing, Winry moves closer to her grandmother, taking care to lower her voice. "Al was in the hall. He said he heard Ed screaming and begged to come in. I told him he can't, and he was so upset, but I just had to keep telling him no. And then I said I had to get back here to help Ed, and he got even more upset."

Both Winry and Pinako glance at Ed, but he shows no signs he heard. "Okay," Pinako starts, "I'll go check on him. Watch Ed's monitor and yell if something changes." She leaves quickly, grateful the elder boy didn't pick up on the situation.

…If only that were true. Because it's pretty difficult not to hear people when they're right next to you, no matter how quietly they're talking.

Ed wants to call after her, to say he doesn't care if it's dangerous, just let Al in, but the words catch on his tongue. He strains his ears, trying to hear them outside. He can't make out any words but he hears the unmistakable high pitched rambling he knows Al breaks into when he's upset, and Ed's heart breaks a little more. What kind of brother is he, putting Al through this?

"Ed? Are you okay?" Winry asks quietly.

"Huh?" He turns his head slightly in the direction he thinks she is, the cloth blocking his vision.

"You're shaking," she says.

"Oh. I'm fine...just...hurts," he says, trying to calm the now apparent tremors running through his body.

"You'll get painkillers soon, I promise. We just have to make sure your nerves are okay." He hears her shift. "I'm sorry..."

Edward mumbles a "s'okay," but his mind is elsewhere now. He tries to take a deep breath, but the air catches in his lungs. He can still hear Granny trying to calm Alphonse down, and it's bringing back all his fears in full force.

Suddenly, he can't breathe.

What does Al think of me? Look at what I'm doing, putting him through so much grief and he's so worried and he wouldn't be worried if I wasn't getting automail and I wouldn't be getting automail if I didn't lose our bodies and we wouldn't have lost our bodies if I didn't convince him to bring Mom back and I'm such a horrible brother and I just messed everything up and—

"Ed!"

He can faintly hear Winry's voice but can't focus on it. He feels fingers lace with his own, hearing disjointed soothing words, but all he knows is his breathing is way too fast but he just can't get enough air and everything is still on fire and he feels like he's about to be sick again. He doesn't even notice Al has calmed down, because it's all in his thoughts, and he's so afraid of his little brother hating him, but he feels like he has every reason to.

"Grandma!"

The door flies open at the sound of Winry's shriek, and Pinako orders Alphonse away, shutting the door and rushing over. "What happened to him?" she demands.

"I don't know!" Winry cries. "He just started shaking and said it hurt so I tried calming him down but now he's breathing funny and his heart rate's elevated and I don't know what's wrong!"

Pinako looks over the machine, then his shoulder and leg, but nothing looks concerning. Still, he is breathing much too rapidly, whimpering softly to himself, so something is clearly wrong. What is it?

"Ed? Edward, can you hear me?"

Ed startles at her voice, somehow managing to grip his blanket even tighter. "Granny…" he chokes. "It's all my fault. Al lost his body and it's all my fault. He can't eat anymore and he can't sleep, he can't feel cold or warmth—he's my little brother and I'm supposed to protect him and I did this and...how can he ever forgive me?"

Pinako's heart sinks. It didn't have anything to do with the surgery; he's panicking over his little brother. She swallows the lump in her throat. "Al isn't the type of boy who would resent you for this. Just ask him and I'm sure you'll see."

"No…" Ed whispers, tears streaming from under the rag on his eyes. "I'm—I'm too afraid. I'm too scared of what he'll say…"

"Ed…" Winry whispers, voice broken with her own tears. "Why...why would you say that?"

Ed chokes on a sob. "Because it's true...I killed his body...I killed him and I killed Mom and it's all my fault and I'm trying to help—I'm doing this to help!—but it's just not enough…" He breaks down into hysterical sobbing.

"Calm down, Edward, you're not thinking clearly," Pinako says, putting a hand on his head, only for him to flinch at the touch. "It's just the pain and medicine." It has to be.

"No...no...It's all true…" he murmurs, taking a few hiccuping breaths. "All true...he hates me...he's gonna hate me forever...he's got every right to...I was supposed to protect him...I'm such a terrible brother…"

"No, you're not, you're just upset."

"Why am I doing this...if he's just gonna hate me?"

"I told you, Ed, it's just the pain and medicine. You're just stressed and it's making you think things that aren't true." Pinako turns to Winry. "Is he still looking okay?"

The girl studies the monitor for a moment. "Nothing concerning," she reports.

"Okay, then let's keep going."

"But...it hasn't even been fifteen minutes yet…" Winry says softly.

"I know, but I want him asleep again as fast as possible," Pinako glances back at Ed's tear-stained face. "If something happens, you can blame me, but I don't want to see him like this anymore." Protocol be damned, she's not going to let him stress himself out so much he can't make it through the rest of the surgery—or worse, reject the automail.

Winry swallows, still nervous about breaking protocol, but she knows her grandmother has the experience with this. "...Okay."

Meanwhile, Ed's mind is still reeling from the waves of terror crashing against his skull. Pain and medicine keeping me from thinking clearly...yeah, right. He understands exactly what he's thinking. And it's all true, every single thought.

"Edward, we're going to unplug the monitors in a second. It shouldn't hurt, but you'll probably feel sorta numb for a minute or so, and it might make you sick again," Winry's voice breaks in.

He nods a little, and the Rockbells pull the tubing from his shoulder and leg. He shudders at the sudden empty feeling; he didn't even realize how having his nerves active again made him feel until it stopped. He listens to the Rockbells as they prepare their next sets of instruments. They're still going, no matter what. And even if Al does hate me—which is probably true—it's all the more reason why I need to fix him. Not to earn his forgiveness...There's no point in that now, not after what I did. But even if he can't forgive me, I can still make his body right again. I have to. Because otherwise...I don't think I could ever forgive myself.

Ed feels a wave of nausea rise in his throat, and he's not sure if it's from whatever Winry had been talking about or the overpowering guilt in his soul. Winry sees him swallow several times, and nudges his hand with the bucket so he knows it's there. A moment later, he tears the rag off his eyes and heaves into the metal.

"It's okay, just let it all out," Winry says soothingly. "We can wait until you feel better."

The ever-present, ever-infuriating tears on his face continue streaking down their paths, and all this strain isn't making it any better. Ed chokes on a sob, clutching the stupid bucket and hating the rising humiliation of both being sick and crying so much. Everything still hurts—his stomach, his head, his shoulder and leg—and he just wants it to be over. He knew it would be tough, and he thought he was prepared for anything, but he honestly wasn't expecting it to be this bad.

No...I have no right to talk when Al's got it so much worse…

"How're you feeling? Any better?" Granny asks. Ed nods slightly, laying back against his pillow with a perpetual look of disgust. "How's the pain?"

He looks away. "Can I have the towel again?"

Winry looks nervously between Granny and Ed before picking the cloth off the floor. "I'll go get it damp again." She leaves quickly, clearly not wanting to be a part of whatever conversation her grandmother is trying to start.

"How's the pain?" Granny repeats, and he still doesn't answer. "You know, you're not being tough by ignoring me. I know damn well you're feeling miserable."

"So what?" he fires back. "It's just a little pain…"

"Sure, and being hit by a train is just a little bump."

"It doesn't matter…" Ed clarifies, staring off to the left at some scuffs on the wall. He wonders if Al made those when the Rockbells were trying to save him two months ago. "This is nothing...Nothing compared to what he's dealing with."

Winry freezes in the doorway for a moment, a small whimper escaping her throat. She swallows, forcing her suddenly too-heavy legs to carry her back into the room. She drags the wet rag down her friend's much too tense face, feeling heat radiating through the white cotton. "I think the fever's started," she says.

"As expected," Pinako replies. "Wrap up some ice for him."

Winry nods, leaving again for the icebox next door.

"Did she hear that?" Ed asks.

"Yup," Pinako answers tersely, yanking off his blanket.

Ed looks guilty for a moment, before shaking the expression off. "Whatever. It's true. This pain…" He squeezes his eyes shut. "This pain is nothing."

"You know Al loves you, Edward."

"Yeah. I don't know why."

"Because you're his brother. Simple as that."

"But I ruined his life."

"Far as I can tell, you saved his life.

"Yeah, some life I gave him." Ed grits his teeth. "I'm such an idiot."

Pinako opens her mouth to respond, but before she can, Winry comes back in with the towel—now wrapped around several pieces of ice—in one hand and a thermometer in the other. "Open your mouth." She slides the stick under his tongue and puts the towel on his forehead.

"How bad is it?" Pinako asks.

"101.4. Not unusual."

"Alright then. I'll start the anesthesia again. Add a morphine line to the IV, Winry." Pinako looks back at Ed's face, mind swirling with everything he'd spilled in the past twenty minutes. "Hear that, boy? We're putting you under again to finish the structure. Next time you wake up, you'll have two complete automail ports."

He doesn't react, his mind still elsewhere, and she chalks it up to the fever overtaking his body. At least, that's what she's telling herself. Winry slips the glass anesthesia mask back over his nose and mouth, and in less than ten seconds, he's unconscious once again. She moves to the IV tree, setting up a dosage of morphine and feeding it into his arm.

Once that's done, Winry sets down her next bin of supplies, turning the rongeur over and over in her hands. "Granny?"

"Hm?"

Winry glances at Ed's flushed, slack expression. "He's not going to regret this, is he? He was really upset…"

"No," Pinako says, her voice coming out much more confident than she feels. "He said so himself that this is the only way he thinks he can help Alphonse. And you know how determined Ed is, Winry."

"Yeah, I know, I'm just...worried. I mean…" the girl twirls the metal instrument again. "...I love automail more than anyone, and I'm proud of us for doing it, but...he kind of scared me back there."

"That wasn't Edward talking earlier. That was just his fear, brought on by the stress of surgery. When he wakes up, he'll be grateful, and knowing him, he'll jump right into rehabilitation; I'm sure of it," Pinako soothes. She gives Ed a glance too, trying to assuage her own lingering doubts. "Besides…" She looks at the half-completed ports. "It's a little too late for regrets now."

Winry narrows her eyes, nodding. "Okay. Yeah, you're right. Let's finish this." Winry grips her rongeur with a trembling hand, getting back into position at Ed's leg.

Pinako smiles at the girl's determination, going back to Ed's shoulder. The last phase of the operation is relatively easy, when compared to the stress of messing around with the patient's nerves. But that doesn't mean she can let her guard down; even if the outlets are closed and the nerves safe, building the support structure is still a bit of a gamble. Putting in the pins and bolts always runs the risk of fracturing the bones, and if that happens, the body can't support the automail until it's healed and is much more likely to reject it.

Pinako readies several metal pins that will hold the port in place. There isn't a whole lot of metal that actually attaches to the person, despite how the final product appears. In reality, the only piece that's permanent is a metal ring around the nerve outlets, anchored on by a set of five internal pins and bolts.

A small noise breaks Pinako from her focus, and she looks up, seeing Winry holding her own set of pins and very clearly trying not to burst into tears.

"What'sa matter?" Pinako asks.

Winry just shakes her head.

"Come on, Winry, we're almost done. You can do it."

She shakes her head again.

"Winry. This isn't the time." Pinako wants nothing more than to comfort her granddaughter, but they can't afford any hesitation right now. "You've made it this far. You want to help Ed, don't you?"

"Yes…" Winry whispers. "I just...I didn't think...I'm normally so good…"

"I know you are. And you're going to be one of the best mechanics out there one day. This is a testament to that."

"But I...I don't know if I can do it…" Winry sets her supplies back down, leaning over the table with her head hanging down. "I feel sick…"

"This is the most stressful surgery we've ever done. I don't blame you for feeling overwhelmed. But that doesn't mean you can just abandon your patient. Edward needs you."

Winry lifts her head up, skin pale as she looks at her unconscious friend. She swallows, nodding slightly before picking her tools back up.

Pinako gives the girl one more meaningful glance before picking up her own scalpel. Time to get to work. She makes an incision below Ed's collarbone and inserts the first pin, drilling it right into the tip of the bone. The next pin is bolted into a rib, and the one after that is fed into the trapezius muscle along the top of his shoulder.

Meanwhile, having managed to compose herself, Winry has drilled her own hole through Ed's femur and is anchoring the support rod in his leg. It runs straight through the bone and leaves two external bolts on either side of his thigh. Then, she feeds two vertical pins into the muscle on both sides of the bone, connecting them to the main support.

"Go ahead and finish up, Winry," Pinako says. "I'd rather you be done before we turn him over."

Winry nods, taking another calming breath before readying her metal ring. She sets it at the end of his leg, connecting the vertical pins to it and bolting them in. She looks over her completed work, and despite the overwhelming nausea that's plagued her for the majority of the operation, she feels a twinge of pride. She tests out the stability by pulling on the ring with a tool, but it doesn't budge. Perfect. Winry quickly cleans up any blood and stitches any incisions still open and then gives her grandmother a confident smile.

Pinako returns the smile, and carefully, the two Rockbells turn Edward onto his stomach, making sure none of the IV lines or the anesthesia mask are compromised.

The old woman picks up her final two pins, attaching the first one to Ed's acromion in the same way as its companion in his collarbone. The final piece is bolted into his shoulder blade, and with all the internal parts in place, she's ready for her metal ring. Just like on his leg, the ring encircles the nerve ports, and each support rod is screwed tightly into it. Pinako does the same test as Winry to make sure it stays in place, and closes each incision.

Wrapping bandages over new ports is difficult and leaves the incision inside the metal ring unprotected, so it's easier to just tape individual gauze patches over each set of stitches. Once those are protected, they cover the metal pieces with fitted plaster casts, so he won't be able to mess with them when he wakes. Pinako shuts off the anesthesia and adds a powerful sedative to Ed's IV so he'll stay asleep and still. Finally, they reinsert the tubing into his shoulder and leg (thankful he's unconscious and doesn't have to experience it this time) through a special spot in the casts, and work on packing up.

Winry picks up various tools, dropping them into her bin with dull eyes. She's completely exhausted; that was way more stressful than she thought it would be, even when it would be considered uneventful by automail operation standards. She pulls down her mask, ready to walk out of the room when Pinako's voice stops her.

"Winry." The girl looks in her grandmother's direction. "I'm very proud of you."

Winry feels tears fill her eyes, and she's not even sure why. So, she just swallows and offers a smile of thanks. She carries her tub out of the room, nearly tripping over Alphonse in the hallway.

"Is he okay?" Al immediately asks, instinctively grabbing her arm to steady her.

"It seems like it," she replies.

His demeanor relaxes for a second before he catches a glimpse of all the bloodstained tools she's carrying. "Wait, what does that mean? Did something go wrong? What happened? Why is there so much blood on those tools?"

"No, nothing went wrong," she says quickly, diffusing his panic. "But we won't know for sure how it went for another week. So that's why I said it seems like he's okay."

"...Oh." The armor's helmet nods. "I get it." Winry knows Al's next question before it even echoes out. "Can I see him?"

"Not yet. He's still really prone to getting sick." Al slumps with that answer, and Winry sets her hand on him. "But soon, once he's in the clear. Don't worry." With that she drops off her supplies to be cleaned and changes her clothes before going back to the main house and sitting at the kitchen table with a plate of leftovers. Pinako joins her a few minutes later.

It's quiet for a while, with just the intermittent sounds of eating, until Winry sets down her fork and pushes her plate away, having only eaten about half.

"I never want to do a surgery like that again," she says.

"Well, I hate to tell you this, but you will," her grandmother replies.

Winry looks down. "I know. Doesn't mean I want to."

Pinako slowly chews a piece of broccoli. "I admit, that was one of the worst ones I've done myself. And I've seen my share of rejection cases during the operation."

"Was it 'cause it's Ed?"

"Yes. As a professional, I've always been taught to never work with family or friends." She shakes her head. "But I never would have let anyone but us do that to one of those boys. Especially at this age."

Winry agrees, and the conversation drops off again. It's not awkward, just an air of utter exhaustion, as the two finish their meager supper.

"I set Ed's monitor to go off if it hits certain parameters. I'm going to sleep in the adjacent room tonight, but you can go on upstairs, Winry."

Winry nods, disappearing up to her room with naught a word. Pinako peeks into Ed's room, seeing the steady rise and fall of his chest through medicated sleep.

"Alright, boy," she whispers. "We did everything we could. The rest is up to you now."

I tried to stay as accurate as possible to the medical field in the time period, and some things really surprised me as I was researching. Tape and anesthetics were common by the late 1800s... who would've guessed?

Anyway, thank you once again for reading, and I hope the Tumblr post helped! See you next chapter!