If you are trying for the UFO Ending, this is the first place you must use the Blue Gem. Go to your items and press use to activate a short scene.
Take the only door available back into the Hospital’s First Floor, which is now switched to the otherworld.
You will still have your map, but all of your previous markings will be gone. Here is a complete map of the area:
Ground Floor (1F)
To the right is a Save Square and a box of Shotgun Shells on the floor.
Walk into the patient wing and check all the doors.
C2 contains a Nurse with a steel pipe. Take her out quickly and grab the First-Aid Kit on the bed.
C1 has another Nurse with a Steep Pipe. Take her out and grab the Health Drink and box of Handgun Bullets on the beds behind her.
All other doors are locked, so take the elevator up to the second floor.
The second floor will have a few Nurses in the hallway. Be prepared for them!
Inside M6 is a creepy painting on the East Wall. Investigate it to find the Dry Cell Battery and Basement Storeroom Key.
Look around the room before leaving to find a box of Handgun Bullets and a First-Aid Kit. You can also read a note on the bed near the painting.
M4 hold two pipe wielding Nurses, be prepared! Behind them is a box of Shotgun Shells and a Health Drink..
The Day Room is a small dead end room. You can find a refrigerator on the floor, but you won’t be able to open it alone. You’ll have to come back to it later.
Now that the second floor is clear, take the elevator to the third floor.
Look directly to the right (James’ left) when you exit the elevator. A painting with 3D arms will be on the stairway door. You can’t do anything with it for now, but remember its location.
Like the last hall way, the third floor will have a few Nurses roaming around.
S11 is a small room with a box of Handgun Bullets and an Ampoule. Look for the note on the bed for something interesting.
S3 is the room you left Maria in. Check it out to find an empty bed and some pill bottles. You can hear someone breathing, but nobody is around.
Head into the store room to find a box of Handgun Bullets, Shotgun Shells, and a First-Aid Kit. We’re done with the store room for now, but we’ll be back later.
Now that the third floor is clear, take the stairwell south of the Special Treatment Room. Inside is a Save Square right when you enter. Head all the way to the basement.
At the bottom is a locked door. Use the Basement Storeroom Key to open it up and head inside.
Inside the Basement Store Room is a box of Shotgun Shells on the floor.
On the left side of the room is a white shelf with red hand prints on it. Investigate the left side to move it, revealing a ladder heading into the basement’s basement (sound familiar?).
Interact with the ladder to trigger a cut scene. After the scene, head down the ladder.
A very small room will be found at the bottom of the ladder. Look around the floor for a bloody spot. Investigate it to pick up the Copper Ring.
We’re done here, so head back to the Day Room on the Second Floor.
Third Floor Elevator Quiz
Take the elevator from the third floor to get back to the second. On your way down from the Third to the Second Floor, a voice will ask you questions. Go to the Third Floor Store Room to answer the questions and receive your prize (you’ll be heading back in that direction in just a little bit).
In the elevator, you will hear this announcer come on and ask you to input your answers in the Third Floor Storeroom. Enter the Storeroom to find a strange box with nine buttons on top. These nine buttons will be the answers to the questions asked earlier. The left side indicates the question, and the top indicated the answers.
The correct answers are highlighted below.
NOTE: This puzzle is optional. You do not need to complete it to finish the game.
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?
Silent Hill Amusement Park
Lakeside Amusement Park
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?
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?
If you guess them all right, you’ll earn:
Shotgun Shells x 5
Ampoule x 2
If you guess any wrong, a mist will come from the ceiling, taking away some of your health.
Now that you have Maria you can open the refrigerator inside the Day Room. The refrigerator will contain theLead Ring.
Next, head back up to the third floor. You can answer the Elevator questions or continue on.
If you remember from earlier, there’s a painting on the door with arms popping out. Use the Copper Ring and the Lead Ring to open the stairway. Down the first flight of stairs is a blue note on the floor, investigate it to get the memo “I took the director’s key”.
Descend into the basement.
Boss Battle / Encounter – Pyramid Head
As soon as you reach the basement begin familiarizing yourself to the way you are running down the hallways. Running is basically all you do in this encounter. This encounter will happen the instant you enter this area. Run to the elevator to survive. This will go much smoothly if you have 2D controls. Just keep pressing down to make it to the end.
On Hard mode, you almost certainly have to slow down Pyramid Head by shooting him, allowing Maria the time to catch up with James. If you don’t do this, Maria will most likely die.
The elevator will open up after the short cut scene. You’re now in the Hospital Lobby on the first floor. All doors in this area are locked, except for the Director’s Room. You can also find a Save Square next to the entrance, but, like the other doors, it too is locked.
Investigate the table to get the Hospital Lobby Key, three new map locations, and to see Laura walking off.