Immediately, on the left from the entrance, there will be a map of the hospital. Head into the reception, ahead on the right. Inside you will find a Save Point and a Health Drink on the desk. In here is also a memo that reads:

[Jack Davis]
He has attempted suicide three
times in the past for reasons
unknown. Although he is normally
a model patient who follows
doctor's and nurse's orders, he
must be watched closely due to
his past pattern of sudden and
violent suicide attempts.

[Joseph Barkin]
His illness seems to be rooted in
the fact that he believes he is
guilty of causing his daughter's
death. His symptoms suggest a
psychotic break and paranoid
delusions. Normally calm, but has
a tendency towards violence when
excited.

[Joshua Lewis]
History of hospitalization as well
as numerous assault, battery and
other violent offenses. He has a
strong persecution complex and
a tendency to solve things
through violence. Extreme caution
necessary.

Save if needed and go into the other door at the end – the “Document Room”. Check the area next to the typewriter for some documents describing a patient, Joseph, experiencing an “other side,” there will be a “Purple “Bull” Key there as well – “...a key to that box” as it is written at the bottom of the document. The memo reads:

The potential for this illness
exists in all people and, under
the right circumstances, any
man or woman would be driven,
like him, to "the other side."

The "other side" perhaps may
not be the best way to phrase it.
After all, there is no wall between
here and there. It lies on the
borders where reality and unreality
intersect. It is a place both close
and distant.

Some say it isn't even an illness.
I cannot agree with them. I'm a
doctor, not a philosopher or even
a psychiatrist.

But sometimes I have to ask
myself this question. It's true
that to us his imaginings are
nothing but the inventions of
a busy mind. But to him, there
simply is no other reality.
Furthermore he is happy there.

So why, I ask myself, why in the
name of healing him must we drag
him painfully into the world of our
own reality?

(Something else is written by hand.)

I got the key from Joseph.
It's probably the key to that box.

Leave the room, and leave the office.

Once you've returned to the main hall, you'll notice just about every door is either locked or jammed except for one, this door is to the staircase near “Examining room 2”. Take the stairs up to the second floor, with Maria inevitably following you. There will be two nurses waiting for you here, take care of them, or run around them and go up the North corridor to the door on the left – the “Woman's locker room.” If you examine the teddy bear on the table you'll get a brief cutscene where James “pricks himself,” but finds a Bent Needle in the process. In the locker next to that you will find a Shotgun. Exit this room and head into the door on the other side of the hallway – the “Men's locker room.” In the bloody jacket hanging from the locker you will find the Examination Room Key, take it and leave the room. Go through the big double-doors across from the straircase.

Directly in front of you, you will find some Handgun Bullets. Next go into “Examining room 3,” which happens to be the first door on the right. You will find a First-Aid Kit on the bed and a typewriter at the end of this room with a four-digit number you will need to either write down or remember. This number is randomized and is never the same.

On Easy/Normal difficulty the carbon paper reads:

i know it i know the number of
the box #### it cant help
him anymore the button key
doesnt scare me so nobody
can stop who i am i don't know
who i am is who i am is who
i am is

On Hard/Extra difficulty the carbon paper reads:

i know it the secret i'll give them
something to deal with this demon
shelter is of no use any more he is
my instrument he must follow my
orders yes, the box will be useless

now i must not forget it ####
that's good he is the lowest now
i too will be free and he will serve
me i am a genius no one can stop
me one can stop me no one can
stop me can stop can stop no no

Exit back out into the hall and go into room M2. One one side of this room you will find a night-stand with an open drawer, inside is the “Lapis Eye” Key, and you will find some Shotgun Shells on top. Beside that, there is nothing else in this room, so leave. This is optional, but if you want to explore the other rooms for items, you can, just be careful as there are two nurses guarding the hallways. In Room M3 you will find Handgun Bullets and a Health Drink guarded by a lone nurse. Room M6 has Shotgun Shells and a Health Drink, also guarded by a lone nurse. Exit the hallway the way you came in and go back to the staircase, then take the stairs back down to the first floor as you are going to unlock and enter the Examination room using the key you got earlier.

Inside the Examination room, there's nothing, so cross over to the Doctor's lounge. Here you will find some Shotgun Shells in the sink, but you main focus is the white board on the wall next to an open filing cabinet.

On Easy/Normal difficulty it says, “3rd floor patient wing hall – 7335”.

On Hard/Extra difficulty it says,

The pin number this month is
"T". Last month it was "X"
and before that it was "Z."
But what are they going to
do next month? That's all they
can express with 4 numbers.

Anyway does the door to the
Patient Wing really need to have
its combination changed this
often?

Head out through the door right next to you, on your right. Head back to the staircase and go up to the third floor.

In this room you will find two stray nurses and a First-Aid Kit at the far Northeast corner of the hall. Go to the double-doors across from the stairs and enter the combination you found from the Doctor's lounge.

Here are the combinations to the 3rd floor patient wing hall for all difficulties:

Easy & Normal – 7335
Hard & Extra – 1328 (Like the letter "T")

Once through the door, turn right and head down the hall to Room S3, which is the third door to the left. Maria will sit down on the bed and tell him she is quite tired form a hangover. He convinces her to lay down and stay here while he goes to look for Laura. Unless you want to try for the Maria ending, you shouldn't check back on her, but you can view two different short cutscenes if you do. Next to Maria, on the nightstand, you can pick up the bloody Roof Key. Exit S3 and head back to the staircase. Ascend to the roof and use the key you acquired in S3 on the door here. On the rooftop, you can cut across to the far corner to read a diary strewn over the ground. I do not recommend you read this unless you are trying to obtain the In Water ending. This is what it says:

May 9
Rain.
Stared out the window all day.
Peaceful here - nothing to do.
Still not allowed to go outside.

May 10
Still raining.
Talked with the doctor a little.
Would they have saved me if
I didn't have a family to feed?
I know I'm pathetic, weak.
Not everyone can be strong.

May 11
Rain again.
The meds made me feel sick
today.
If I'm only better when I'm
drugged, then who am I anyway?

May 12
Rain as usual.
I don't want to cause any more
trouble for anyone, but I'm a
bother either way.
Can it really be a such a sin to
run instead of fight?

Some people may say so, but they
don't have to live in my shoes.
It may be selfish, but it's what
I want.
It's too hard like this.
It's just too hard....

May 13
It's clear outside.
The doctors told me I've been
released - that I've got to go
home.
I --------------

Run to the North, towards the Elevator control room for a shocking surprise.

The red pyramid thing seems to have followed you and silently gotten on the roof to appear right behind James! James turns around to catch a chestful of the blunt end of the aberration's great knife, knocking him through a fence and down through the ceiling of the locked Special treatment room. When James gets up, you will regain control only to realize that your health has hit rock bottom and you need to use a First-Aid Kit.

The third door from the right can be entered. On the wall next to that it says: "If Joseph looks calm, he can be taken out of his cell." Enter the small padded room and examine the wall on the left of James. There should be a four digit number written in blood, but sometimes very hard to make out. Use your best judgment here and write the numbers down, or memorize.

This is what it says:

####
Tern tern tern the numbers
better not forget them
So i'll right them down here
The other one, my secret name

Exit, and unlock the door to exit back into the hallway. Go into the second hallway through the double doors and go straight to the end of the hall to the door on the left, Room S14 (you will encounter a nurse and two mannequins along the way).

In Room S14 you will discover a message on the wall that reads: "Louise, I'll take care of you four ever. It's my destiny!" and a box with two four-digit combination locks, and two key locks. By now you should have the two keys needed, the “Lapis Eye” Key and the “Purple Bull” Key, so use them. You should have the combination to the two locks also. If you can't remember what they are, simply access the Memo section in the Inventory. The combination you found in blood in the padded cell (“Tern tern tern the numbers”) goes into the turn-style lock and the combination found on the carbon paper (Imprint on carbon paper) goes into the other. Once you unlock the box, you'll receive a Piece of Hair, turn around and exit the room.

Run down the hallway and enter the Shower room on the left. You'll notice a bunch of green dye on the ground surrounding a drain, inside you'll see something stuck inside. If you didn't already guess, you'll need to combine the Bent Needle you got off of the teddy bear with the Piece of Hair you just got to fish the Elevator Key out. From here, you can simply exit and make your way to the elevator to the right, or you can enter Room S11 for a Save Point and a Health Drink.

Once on the elevator, take it down to the first floor. If you want, go into room C3 for some Shotgun Shells and Handgun Bullets. Go into room C2 and run towards the end of the room to trigger a cutscene.

--->

Laura will be happily playing with her teddy bears, until James calls out her name. Laura, surprised that he knows her name, won't tell James how she knows about Mary at first, but then she discloses that she met her last year at the hospital. James calls her a liar as Mary was supposedly already dead then. Laura decides to go with James out into the hallway. Suddenly, she seems to remember there was something important she needed to get – a letter from Mary, which happens to be in a locked room. James heads inside as Laura stays behind just to slam the door shut behind him, revenge for calling her a liar earlier. James notices strange monsters coming down from the ceiling and starts to panic, banging on the door, and telling her to open up. Laura refuses after he calls her a “snotty little brat” and she leaves him in there to deal with the monstrosities on his own.

--->

If you have the Blue Gem, you can use it here, in the rainy garden, to help you get the UFO Ending. This is one out of three places in which you need to use the Blue Gem.

Exit the garden through the double doors. Straight ahead you'll find some Shotgun Shells and a Save Point to the right. Exit through the double-doors across from the save. In the next area, you can just turn left and go into the elevator right away, or explore this floor for items. Room C2 has a nurse in it, but kill it and grab a First-Aid Kit. Room C1 has a nurse as well, but kill it to grab some Handgun Bullets and a Health Drink. When you're done, head to the elevator.

Take the elevator up to the second floor. There should be three nurses here. Turn right from the elevator and go into the last door on the left – Room M6. There's Handgun Bullets, a First-Aid Kit, and in the wall, surrounded by a drawing of reaching hands, a Dry Cell Battery, and a Basement Storeroom Key. To the right of this, on a bed is a memo that reads:

I was locked up inside
the basement's basement.
It was so small and dark
and I was so afraid.
I dropped my precious ring.
But I will never,
ever go back there.

Head out of the room. You can either go back into the elevator, or explore this area for items. Room M4 has two nurses in it, along with a Health Drink and Shotgun Shells. The Day room has a fridge in it, but we'll get to that later as James cannot open it by himself. Once you're done head to the elevator.

Take the elevator to the third floor. Go left and head out of the double-doors at the end of the hall, otherwise you can search for items. Room S11 has Handgun Bullets and an Ampoule, there is a scrap of paper on the bed with a doodle that has something written on it.

She is an angel no one knows only
I can see the Lady of the Door
they cannot walk along her Bridge
of Thread they fall from the weight
of their crimes.

Like bloated and ugly corpses
their sins she devours them
sin and sinner alike she saves
me she is an angel.

When you're done exploring, go through the double-doors at the end into the next hall. There are two nurses in this area. Go into the door across from you, into the staircase. A Save Point is on the wall. Take the stairs down and down as far as you can go. You will hear a loud squeaking. You'll use the key you got on the door at the end. Pick up the Shotgun Shells and push the shelf with the bloody hand prints on it. Try to go down the ladder for a cutscene.

--->

Maria will come into the room, surprised to see James there. He mistakes her for his dead wife again, but says “anyway... glad you're alive.” she blows up at him for leaving her behind... she says she was almost killed. She throws herself into James' arms and weeps, telling him to take care of her. Maria says she met Laura before and she feels she needs to go after her in order to protect her.

--->

Go down the ladder through the area that was once behind a shelf. You will find a Copper Ring on the floor. Head back up the ladder and out the door. Maria will follow. Head back up to the third floor, with the save point (and I do recommend you save), and exit the staircase.

Go into the West wing hallway, and into the elevator, careful of the nurses. Head down to the second floor and the radio will start to play something funny. It seems to be a game show called “Trick or Treat!” starring James – strange huh? The announcer will ask three questions.

--- "Trick or Treat" Puzzle --->

Question one:
Merry-Go-Round, haunted house, roller coaster, ferris wheel and tea cups. Silent Hill is home to a thrilling amusement park that both children and adults love. The question is: What is the name of this amusement park?

1. Fantasy Land
2. Silent Hill Amusement Park
3. Lakeside Amusement Park

Question two:
Silent Hill witnessed a gruesome murder a few years back.
A brother and sister were playing in the road when they were attacked and chopped into pieces with an axe. Torn flesh, smashed bones, splattered blood, and finally... What a terrible tragedy. What gruesome end to such innocent lives. What was the name of the murderer who committed this vile act?

1. Walter Sullivan
2. Scott Fairbanks
3. Eric Gein

Question three:
South of the lake is a deserted old neighborhood called South Vale. From there to Paleville, the central resort area northwest of the lake, there's only one road you can take. Just one road, no more. The third and final question is: What is the name of that road?

1. Bachman Road
2. Rendell Street
3. Nathan Avenue

The answers to those questions will come into play very soon. If you need help figuring out the answers above, read the following:

For question 1 and 3, you can simply open your map and check it. For the answer to question 2, assuming you haven't already played SH4: The Room, you can check the memo titled "Article about murder incident" – it was the article found in the trash chute.

------>

Once you're off the elevator, head to James' left and down the hall to the end, into the Day room. Go up to the fridge and Maria will help James open it after saying that James “is supposed to be the big man around here.” She lets him have the Lead Ring, found inside.

Exit the Day room and head back to the elevator, then back to the third floor.

Optional:
If you want to participate in the “Trick or Treat” show, and want a bunch of items, head into the East wing hallway of the third floor, then into the Store room. Inside you will find a First-Aid Kit, Handgun Bullets, and Shotgun Shells on the shelf in the back of the room. One a small table you will find an elaborate box (that wasn't there before the game show radio chatter) with “1, 2, 3” going horizontally and “Q1, Q2, Q3” going vertically.

If you didn't already guess, the answer is 3 on the top row, 1 on the middle row, 3 on the bottom row. Inside the box there will be FIVE Shotgun Shells and TWO Ampoules.

Go back into the West wing hallway to the elevator, but do not go inside. I recommend you kill the nurses in the area as they can get some shots at you. Go to the door next to the elevator and use the Copper Ring and Lead Ring (combine them, it is faster), to place them on the hand coming off of the wall. This will unlock the door, so head inside.

You'll wind up in a second staircase. Take it to the bottom and you'll go by a note on the ground that reads:

I took the direckters's key – the
one to the mooseum. I hit it
behind the preying woman when
I went out for the day trip. I
picked it up but did not steal
it. I'm not a krimminal.

Before you go through the door at the end of the staircase read the strategy below.