Notes: This story is set in the same universe as Arthur Kirkland's Guide to Being a Big Brother. While reading the prequel first could offer a better insight on the characters and their dynamics, it's not needed to understand the plot – it's basically just an explanation of how Matthew and Alfred ended in Arthur's care. (In case anybody's curious, I have also added a brief recap in the notes at the bottom.)

I'm not a doctor, so there might be inaccuracies in the medical part, in spite of my research. This isn't the presentation of a clinical case, after all, just something I'm writing in my spare time to have fun.
On the same note, the story is written from a third-person limited POV; there will be some misconceptions and erroneous notions reflecting the narrator's views.

I hope you guys will enjoy it! And please review :)

Disclaimer: I don't get any profit from writing this. Hetalia belongs to its creator Hidekaz Himaruya; credits for the cover picture go to ルゥコ＠ (pixiv member ID=55970)

Chapter One

On Friday morning, Matthew woke up to muffled yells coming from downstairs. He groaned, burrowing himself deeper under the blankets as if they could somehow block out the sound. The only accomplishment that came out of the movement was to increase the dull pain pulsing in his lower abdomen.

Matthew would have liked to call himself surprised, or even concerned, but there was no fooling himself. Over the previous months, the scenario he was facing had become a familiar companion to his days. Whimpering when his shifting once again made the pain flare up, Matthew turned to the side table and paddled for the phone before lifting it in front of his face. It was early, there was no need to get up yet – but Matthew knew that he wasn't going to be able to fall asleep again, between the screaming in the background and the throbbing in his belly. He closed his eyes for a moment and took a deep breath, trying to gather the strength to face the day. Matthew was expecting it to be hard.

What he wasn't expecting was the searing agony that pierced his lower abdomen as he sat up, making him double over with a small cry. White swallowed his vision, the acrid taste of bile singed his throat.

Matthew swallowed down and forced himself to take a deep breath before he attempted straightening up again – slowly, this time, and with his hands firmly pressed against his stomach. His body didn't like it, once again rebelling with an intense burst of pain. Matthew frowned and looked down at his feet, nibbling on his lower lip.

In truth, he wasn't new to random pains. He had started feeling ill and shaky the previous morning, with a dull pain pulsing around his navel that had ended up growing more and more intense over the course of the day. He had never imagined it could turn so bad, however.

How typical. Life's always full of surprises, isn't it? I don't know how I could have forgotten this.

A couple of experimental shuffled steps told Matthew that standing straight was almost impossible, the pain intensifying with sharp stabs at each movement. He clenched his fists and took a deep breath, trying to collect himself. If his features showed any sign of discomfort, Arthur was going to notice. Not only he was going to keep Matthew home from school when he had already missed more days than it would be wise (his perfect grades weren't suffering from it, yet, but for how long would he be able to keep it up?), Arthur was also going to worry to no end without ever finding a solution. Given his past history with illnesses, Matthew couldn't blame his brother – and that was why avoiding the scenario altogether was imperative. Which was completely up to Matthew.

Trying to collect himself, he took his sweet time to prepare for the day. Half an hour later, he was cleaned up and dressed – presentable, in spite of the grey pallor that donated an unflattering ill hue to his already too pasty skin. Matthew elected to ignore it, just like he was desperately trying to keep his mind off the agonizing throbbing inside his abdomen, that hadn't diminished.

I have had worse, and I was only a child. I can handle this.

Matthew kept repeating the words like a mantra, but once he got out of the room, his distress only intensified. That time, the pain only played a minor part in it – the ongoing argument was just too loud for him to push it to a remote corner of his mind.

"Just a stupid letter, Arthur!" Alfred was yelling, his voice heavy with all the disdain he was capable of. "What does it even matter? I cannot believe you're making such a fuss over this!"

Matthew flattened himself against the wall as he shuffled to the kitchen, hoping not to be noticed and dragged into the discussion. He shouldn't have worried about that, nobody had the time to pay attention to him.

Arthur's voice joined Alfred, trembling with rage.

"Only a letter? Let alone the fact that this is hardly your first failing mark, which is an issue itself, why did I have to learn it by going through your graded essays? You should have told me as soon as you got home! Instead I—"

Matthew had reached the kitchen. He closed the door to muffle the sounds and let himself double over, clutching his abdomen. The pain had intensified in agony during the short trek, it felt like a knife twisting into his intestines. Matthew was perfectly aware of the cause.

In the living room, Alfred resumed yelling.

Matthew resolutely turned a deaf ear to the sounds, focusing on the array of cereals into the cupboard and pretending not to hear the hurtful words Alfred and Arthur were spewing against each other. In truth, Matthew didn't even need to hear anything to know what was being said. He could have recited the entire argument by heart: the words might change from time to time, but the meaning was always the same.

Matthew's stomach made a summersault that brought bile to the back of his throat.

Breakfast was out of the question. The previous day, Matthew had skipped lunch and his dinner had ended up making acquaintance with the toilet not long after having been ingested. With the pain plaguing his abdomen, that morning wasn't shaping up to be anything better.

Out of habit, Matthew cast a furtive glance behind his shoulders. He shouldn't have worried, Arthur was still yelling at Alfred in the living room. He was at the 'wasted potential' part of the lecture – Matthew didn't want to hear it. He methodically took out a bowl, poured just some drops of milk into it, and smeared them over the surface to give the impression of an eaten breakfast. A pang of guilt flared up in his stomach at the thought of wasting food, but it was still better than making Arthur realize he hadn't eaten. Trying to drown the sound of the discussion, Matthew took to methodically washing all the bowls already inside the sink. He turned off the water just in time to hear the door slam closed with a thud that made the house tremble and Matthew's stomach coil in discomfort, increasing the pain in his abdomen. He had to bite his lower lip to restrain a moan, willpower alone prevented him from doubling over.

Just a moment later, dragged footsteps announced Arthur's entrance into the kitchen.

"Oh, Matthew! Good morning. Have you already had your breakfast?"

The forced colloquiality of the words couldn't hide the slight tremble in Arthur's voice. When he turned, Matthew's gaze was immediately captured by the violet shadows that were painfully evident on the tight skin under his brother's eyes. Another intense spike of pain stabbed his stomach, accompanying the clenching of his chest. Matthew stubbornly refused to double over.

"Mmh…" he muttered in assent, doing his best to offer Arthur a reassuring smile.

There was no way he was going to trouble his older brother over something as trivial as a bad – no matter how excruciating – stomach-ache. Arthur certainly didn't need another concern added to his plate – even less if it was nothing more than a product of Matthew's too anxious mind.

Arthur reciprocated with a tired smile of his own and a small nod.

"Good. I trust you've taken your antibiotic, haven't you?"

A lump surged in Matthew's throat. He nodded, using all his willpower not to let the smile slip from his face. Not only he hadn't taken the antibiotic that morning – he was feeling too nauseous for it, he knew he wasn't going to keep it down – the dose from the previous evening had joined the rest of the meal down the toilet drain. Arthur didn't know. He was imperative that he didn't become aware of that second instance, either.

The young man's exhaustion was written as clear as daylight in his slumped posture and drawn features. On the top of the already taxing concerns of a twenty-year-old having to deal with running a family, the constant fights with Alfred were draining Arthur to the point that Matthew was surprised he hadn't collapsed yet. And how could Matthew add another weight to Arthur's shoulders? The mere thought made his lungs tighten so much that he could hardly draw a single breath.

Moreover, it had been more than six years since Matthew's spleen had been removed. Other two, and he would finally live like a normal person and be free to stop taking his prophylactic antibiotic. Missing two doses wouldn't cause any harm, no matter how much Matthew's skin crawled with uneasiness at the thought of disobeying his doctor's orders.

Any doubt evaporated in front of the tired yet unmistakably earnest smile that blossomed on Arthur's lips.

"You're such a good boy…" he exhaled, "I know I can always count on you."

Shame crawled up Matthew's stomach.

"I have to go, I'll miss the bus," he muttered, ducking behind Arthur to rush out of the kitchen and ignoring the painful jolts in his lower abdomen.

He couldn't stop himself from noticing how a bit of tension seemed to leave Arthur's shoulders, allowing him to stand straighter. Matthew felt sick at the thought.

A good child? This couldn't be further from the truth. I'm just an anxious, selfish wreck.

If Matthew were a good child, he would fully understand that Arthur just had more vital concerns than constantly paying attention to him – it just wasn't possible, in their situation. If Matthew had truly managed to convince himself of that, his body wouldn't rebel that way in order to be noticed, making Arthur waste precious energy over silly concerns. Matthew was aware of that. And, at the same time, dwelling over it wasn't going to help.

With a tired sigh, Matthew hauled up his school bags and headed out of the door after saying goodbye to Arthur. The cold wind that bit his cheeks made him shiver, bothering him far more than it should have. On the flip side, the combination of cold and heavy bags allowed Matthew to walk slightly hunched over without anybody questioning it. It was a small blessing, the jolts of pain in his lower abdomen were getting more and more intense and harder to hide. Matthew would have been ready to drop to the ground and cry in pain.

Instead, he gritted his teeth and trudged on to the bus stop. By the time he reached it, he was dizzy and out of breath, the throbbing in his guts so intense that he feared he would pass out. Matthew let himself slump on the bench and hugged his knees in front of his chest, trying to find a position that would give him some relief from the pain.

"Woah, you look miserable. Did Art yell at you, too?"

Matthew started at his brother's voice. He hadn't realized that Alfred was still at the bus stop as well, sitting at the other end of the bench with his legs spread open and his hands folded inside the pockets of his bomber jacket. He would've been the picture of carelessness, if not for the thin lines of anger still creasing his forehead and the barely repressed fury darkening his eyes. Matthew missed their limpid blue. Every time he looked at that foreign rage burning behind them, he felt like he was being kicked in the chest.

He shook his head.

"Arthur didn't do anything, I'm just tired. And…" The hesitation lasted only a fraction of a second. Matthew couldn't bear his family arguing any longer. "You know, he wouldn't yell at you, either, if you just talked to him instead of just him having to find out everything on his own."

Alfred snorted and gave an exaggerated eye-roll.

"Who, Arthur? Don't make me laugh, Arthur doesn't do 'talking'. He just decides what's the best for us and demands us to follow through it. He has already made up his mind, there's no way to make him reconsider. Hell, it's not even about getting him to change his mind – he doesn't even get to the 'listening' part!"

Another sharp burst of pain squeezed Matthew's intestines. He hugged his knees closer to his chest, trying to breathe through the agony.

"But… he does have a point, Al. I mean… not with everything, but… you're really smart, if you just… studied a little… You'd have better grades, and it wouldn't even be so much of an effort… You really are kind of throwing away this opportunity…"

Matthew's voice trailed off in a whimper, his chest tightening at the recognition of the fury that warped his brother's features.

"Of course," Alfred spat out, gritting his teeth. His hands clenched into fists as his entire body tensed. "Of. Fucking. Course. I don't even know what I was expecting from you. Always Arthur's little bitch, aren't you? For fuck's sake, Matthew! Can't you see he doesn't care for you in the slightest? All that that matters to him is appearance – to be seen as the perfectly proper big brother who takes perfect care of his equally perfectly proper and boring younger brothers. There's nothing deeper behind it! Why are you still snivelling at his feet? It won't change anything. Arthur won't magically start caring for you just because you're an obedient little goody-two-shoes! You'll always be invisible to him, always a second thought!" Alfred gave a violent shake of his head. "By now, you should know that I'm the only one who truly cares for you. Why are you still siding with him?"

Matthew couldn't breathe, Alfred's word pressed against his chest with the weight of a stone. With his head swimming and his racing heartbeat pounding in his ears, Matthew could only look at the utter disgust spelt out in his brother's features.

"And you know what? I'm sick and tired of getting blamed for everything as I wait for you to finally develop some critical thinking skills. You're no better than Arthur, at this point. Don't fucking talk to me until you've got some sense back!"

Alfred jerked up from the bench and walked in swift strides to the road, just in time for the bus to appear from the corner. He got into it without sparing a glance at Matthew, the tight fists around his backpack's strings quivering in rage.

Matthew was paralyzed. Only when the bus driver cast him a questioning glance, he was reminded that he had to get in. He got up on shaky legs and automatically walked to the bus. Somehow, he managed to ignore both the agony raging in his lower abdomen and the tears scorching against his eyelids and offer the driver a shaky smile.

Without meeting anybody's eyes, Matthew found a spare seat and curled into it as he tried to compose himself. No matter how much he forced himself to even out his breathing, however, he couldn't soothe the ache in his chest or in his abdomen. He let his head rest against the window, savouring the feeling of the cool surface against his clammy skin.

When did everything start going so wrong?

In truth, Matthew had a quite precise answer: the downfall had waltzed into their life in worn-out and faded tennis shoes along with Allen and Allyson Jones. Alfred had always had a rebellious streak, but hanging around those twins he had bonded with because they shared the same surname had turned it into a meaner, uncontrolled force that had slowly taken over their lives. Well-meaning and trusting as ever, Alfred hadn't been able to recognize the real malice hiding behind the façade of innocent, misguided teens with a rough past. When Arthur had urged him to be cautious, he had retorted that Allyson and Allen deserved a chance like anybody else. When Matthew had reported that they were vandalising the school properties, scaring and bullying younger teens and smoking weed, Alfred had laughed and told him he shouldn't listen to every rumour that went around, that they were nothing but stereotypes.

The Jones twins must have seen something special in Alfred, something that could be useful to them. They had initially acted tamer around him, only to slowly lead Alfred into the mindset that society and norms were oppressive, that going against them was the only way to truly help people. They had taught him that school didn't matter and that the rules Arthur put in place were only meant to hinder Alfred from letting his true potential shine. And Alfred had swallowed everything, changing bit by bit until he was just a shadow of Matthew's brother.

Eventually, something had happened that had opened Alfred's eyes. Matthew wasn't aware of what had transpired, his brother hadn't confided in him in a long time; all he knew was that Alfred had abruptly cut his ties with Allyson and Allen and hadn't regretted their departure at the end of the summer. For a couple of weeks, Alfred had even been nicer to Matthew, almost back to his old overprotective yet well-meaning personality. Allen and Allyson Jones, however, had left a strong, dark impression that had seeped into Alfred's mind and planted its dark root into his heart. The fights with Arthur had started to burst out again, more violent and frequent than ever.

Now, Matthew considered himself a quite forgiving person. Before casting any judgement, he always did his best to look into other people's motives and try to understand their perspective. He would be able to say without hesitation, however, that he hated Allen and Allyson Jones. The mere recollection of those malicious smirks and those eyes, of such an intense warm shade of brown that they almost looked red, made hot fury surge inside Matthew's chest. Allen and Allyson Jones had ruined his family and his life.

But, more than anything, Matthew was tired of getting caught into the crossfire. He was so tired that his body had started faking illnesses and pains in response. "There's nothing wrong with him. It's psychosomatic," the doctor had said when Arthur had rushed Matthew to an appointment after four days of unexplained slight fever and stomach-ache (Matthew had tried to hide it from Arthur. He had done his best, but he hadn't been expert enough to completely cover the signs of his too frequent vomiting and the weakness that accompanied it).

At that time, Matthew hadn't known what the word meant, but he could perfectly recall how shame had crawled up his stomach as he lay on the cold bed, under the doctor's unforgiving stare. Later, he had realized why the doctor was judging him so badly: 'psychosomatic' meant 'not real'. It was just Matthew's body being whiny and claiming the attention its owner was so desperately trying not to ask for, knowing just how many more pressing issues Arthur had in his hands. Selfish. That was what Matthew's illnesses meant.

Matthew gritted his teeth against another spasm of pain that was shortly followed by a wave of nausea. He refused to let even a moan go past his lips. In spite of the embarrassing display his body was giving, there was still one thing he had control over: his reaction. No matter how bad the pain might get, he wasn't going to add other fuel to the fire.

Matthew's resolve was thoroughly tested during the following hours. Normally, he would feel a bit better once he had left home, but that day, the pain wasn't giving him a single moment of respite. If anything, it seemed to be growing worse. By midday, Matthew could no longer stand straight. He felt like a scorching knifes were embedded into his lower abdomen, twisting at every movement.

Matthew had never blessed so much his being unremarkable, he probably wouldn't have been able to hide his discomfort from anybody truly noticing him. Fortunately, he didn't share any class with Michelle or Emil that day, and Carlos was in Cuba visiting his grandparents. His luck extended to the fact that there wasn't any test, but that was also where it stopped.

Matthew spent the entire lunch break curled up in a bathroom's cubicle, getting rid of bile and doing his best not to bawl from the pain. He was quite sure he had never experienced something like that – and probably, the intense hockey practice he would have to face in the afternoon had something to do with it.

In theory, hockey practice should have been suspended as the coach wouldn't be able to attend, but there was going to be an important match the following week; the team couldn't afford to miss any training. Because of that, Ivan had elected to ignore the rules and follow with the practice even if there wasn't any supervisor. The thought made Matthew's chest tighten. He was uncomfortable with going against the rules, but he had already agreed to it, he couldn't take it back.

'You're really trying to give up on me, aren't you?' he scolded his body, but he didn't even have the energy to be truly angry anymore. He was just tired.

As he willed his churning stomach to settle down, Matthew let his head rest against the wall. The ceramic tiles felt icy under his skin. Matthew wouldn't have been surprised to find a fever accompanying the general feeling of illness, it wasn't unusual – but there was nothing he could do about it.

Somehow, Matthew found the strength to climb to his feet at the end of the break. With his head swimming and his abdomen screaming in agony, he dragged himself to his afternoon classes.

The following periods passed by in a daze. Matthew was hardly aware of his teacher talking, all he could think about was the pain consuming him. He mentally pleaded for it to stop, tried all the calming techniques he had even vaguely heard of, but to no avail. By the time the bell rang, the agony had only worsened.

Matthew wanted to curl up into a foetal position and sob out all the pain he was feeling. But that meant attracting the attention of the teacher. And feeling sick at school meant being sent to the infirmary. Then, the nurse would have to call Arthur, who would worry to no end. Matthew couldn't forget how exhausted his older brother had looked that morning. He couldn't do that to him, not over a fake ailment that shouldn't have been happening in the first place. Matthew just couldn't.

Mindful of that, he gritted his teeth, forced his body to straighten up ignoring the excruciating stabs of pain and walked with single-minded determination towards the changing room, trying not to pay attention to the way the floor seemed to tilt under his feet.

Fortunately, everybody seemed to be too concerned with the imminent practice to pay attention to the way Matthew wobbled into the changing room, and they were used to him changing inside the bathroom. Matthew didn't like to think about the thin scar marring the left side of his abdomen, nor did he fancy the idea of other people seeing it – mostly, because it meant questions that would make his mind linger on something he only wanted to forget – but, for the first time, he was grateful for its presence.

Matthew had forgotten how many movements were required for an act as simple as changing his trousers, but he almost teared up several times when the agony raging in his lower abdomen increased to the point that it turned his vision grey. None of his teammates was there to witness that, nor did they see the several minutes Matthew needed to rest before he could even attempt straightening up from his crouched position, or how the searing pain when he finally accomplished the task distorted his features in a grimace.

By the time Matthew got out of the bathroom, everybody was already on the move.

"Come on, Matt!" called Mikkel, "On the ice! We need all the training we can get!"

In spite of knowing how important the upcoming match – and, consequently, training for it – was, Matthew found himself mourning the lost opportunity of a missed practice. Writhing in pain on his bed seemed a lot more appealing than a hockey match. At least, skating while slightly doubled over didn't raise any question, and the headgear prevented his teammates from spotting Matthew's pained expression, but that was about where anything positive stopped.

With each movement of his legs, Matthew drove a knife deeper into his abdomen. The searing pain was engulfing all his senses and narrowing his vision, it was all Matthew could think about. Not the game, the puck or the other players. There was only the fire eating him from inside.

Matthew was suddenly torn out of his stupor by a voice that rose above the general buzzing, calling his name in a panicked intonation. He raised his head to see Ivan coming at him at full speed, horror shining in his eyes.

There was no time to move away. Matthew barely managed to duck to his right. For a moment, he thought he had avoided Ivan – then, the end of the stick caught his left side at full force.

An agonizing fire exploded in Matthew's lower abdomen. This time, the boy couldn't restrain the raw scream that was torn from the depths his throat. He had no more control of any of his limbs, he couldn't feel his legs or arms – all he could feel was the agony tearing his gut in half. Perhaps, that was exactly what had happened.

Mercifully, Matthew's senses soon vanished in the black that swallowed his vision.

(word count: 4,299)

Notes:

Allen and Allyson Jones are 2P America and 2P Nyo America (they won't make any other appearance, they just belong to some key elements of the backstory)
Michelle is Seychelles
Carlos is Cuba (actually two years older than Matthew but got held back)
Emil is Iceland
Mikkel is Denmark

Family situation as explained in Arthur Kirkland's Guide to Being a Big Brother:
Arthur is Alfred and Matthew's stepbrother. His father died when he was 2, and, years later, his mother moved to America and married Alfred and Matthew's father, who was already taking care of Alfred.
Arthur also has 3 much older brothers, but they never moved to America (or bonded much with their new family) as they were already of age when their mother remarried.
Alfred and Matthew's parents divorced before Matthew was born. Matthew stayed with their mother in Canada (and took her surname, too).
When Matthew was 8, his mother died in a car crash and he went to live with the rest of his family in America.
(Following the same car crash, Matthew got his spleen removed because it had been ruptured by a broken rib.)
When Arthur was 18, their parents died and he got custody of Alfred and Matthew.
If you have any question, don't hesitate asking!

English isn't my first language. I'm doing my best, but it's likely I've still made some mistakes or wrote oddly-phrased sentences. I apologize for this!

(On a side note, please keep in mind that the story is filtered through Matthew's POV, and he has quite a skewed view of what 'psychosomatic' truly means.)

I have tried to start this story with a different approach: shorter but more frequent chapter. (Let's see how long before I turn back to my regular 10k words chapter, lol). For now, I'll try to post a chapter about every week/ten days, but I also have another story I'm working on so I'll have to juggle with that one as well.

If you want to have any further update, you can find me on tumblr! The username is feynavaley, and anything relevant to my fics is tagged 'about feyna's writing'.

Until next time! :)