You return to Vincent. Check the dead girl on the floor and take the Shotgun from her. Also take a Health pack by clicking on the curtain. Go to the toilet room on the 1st floor. Check the toilet to see there's something shiny inside. Use the chain to get a Rusty key. Upon the exit you'll meet a new monster which can be real tough, so you may want to equip the Shotgun before going out.
Go to the 2nd floor and unlock the first room to the left with the Rusty key. Check the strongbox on the wall to the left. Use the hand on it to read the puzzle tale. The answer would be 1, because only you're going to the hospital. Enter 001 and take Black pearl from the safe. Kill the monster in the hall. Go to the room with the seal and move to the nightmare world.
Go to the first floor by the elevator. Check the last door to see there are three bottles here and a button on the floor. You need to get a bottle with 4 gallons of sand in it. To do it
make these exchanges between bottles: from 8 to 3, from 3 to 5, from 8 to 3, from 3 to 5, from 5 to 8, from 3 to 5, from 8 to 3
and then put the 8 gallons bottle on the button. Get Yellow pearl from the hanging cocoon.
Now you have four pearls, so go to the last room on the 3rd floor. You better save the game now. Try to enter the door. You'll get a puzzle
with a message. You need to insert pearls according to the expressions mentioned
in the message. If you examine pearls in your inventory, you'll get their descriptions (for some reason
you can read them only in the real world): red - concentrated rage, blue - so beautiful that makes you cry, yellow - happy, black -
frightening and cold. So put the pearls in certain order clockwise starting from the left slot: blue (sad), yellow (joyful), red (angry), black (dead). Enter the room for the final battle with Karen. Aim for the head with your shotgun. After the battle the game is finished.