The game begins with a dialogue between Karen and Lucas:
You play as Lucas and you are now in a Locker Room of the Hospital. Look at the locker at the far end of the room. It has a nameplate with Karen's name and is locked with a padlock. A nameplate on the nearest locker on the right is a bit loose. Get Bill's Nameplate. Exit the room. Turn to the left, go forward and turn to the left once more. You should find the Map on the wall besides a door. Obtain it and you'll find that you're currently on the 1st floor. Enter the door besides the map. Look at the painting of two adults and a child locked inside a cage on the wall. Take the red Wax Crayon from the small table besides the wall. Now go to the Basement and enter the Laundry. Open the washing machine to get a dirty Doll from it. Now go to the 2nd floor and enter the only one unlocked Patient Room. Check the wall to find some Roman numerical - II V IX I. Return to the 1st floor and find the door with a code lock. Use the code lock to enter the number 2591 (the Roman numerical) and enter the door. A dialogue with Karen will start:
After the dialogue obtain the Notepad from the corpse's grip. The Notepad says: "Mark me as a dead man. Mark me with red. Mark my way straight to hell". It is a hint to what you should draw in the painting. Return to the Waiting Room and use the Wax Crayon on the painting. Connect the rod dots to draw a triangle like this:
The triangle on the drawing is glowing now. Touch the marking to enter the Otherworld. You can now use this symbol to switch between the Normal World and the Otherworld. Go to the room in the southern part. There will be some twitching meat hanging from the ceiling in the string bag. It has a paper attached. Take the Paper. The paper says: "Brad killed himself. Bill is the father of Marie. Sarah is gone. Marie's offspring Lucas is here. Bill is hanging from the ceiling. Karen is dead". Now exit the room and go to the Locker Room. There's a cage there with a nameplate besides it. Take Lucas' Nameplate. Get to the Basement and find a door with a metal plate near it. It has nameplates on it, but some are missing. Put Lucas' and Bill's Nameplates and examine the plate. Now you have to press three nameplates in the correct order. To do that you have to check the Paper and find some connected persons: "Bill is the father of Marie. Marie's offspring Lucas is here". So press nameplates in the middle column in this order: Bill, Marie, Lucas. The door will unlock. There's a birdcage in there. Put the Doll into it and the slot in the lower part of the birdcage will open. Get the Small Key from it. Karen will speak again:
Return to the Normal World and go to the Locker Room. Use the Small Key on the padlock of Karen's locker and open it:
No go to the Otherworld and return to the Locker Room to check Karen's locker. It will be opened and you'll find dead fetuses in it. Examine them:
Go to Karen's office on the Basement floor as you were told (the door with a metal plate besides). You will find Karen there. Speak with her:
Use the Steel Pipe on Karen's head:
"I know everything. Fields of red. The flesh burns. Meet me at the hospital in Silent Hill or I will tell".
Now you play as Vincent. Turn to the right and take the Map from the wall. Try to enter the door nearby - the voice will speak:
Go to Karen's Office in the Basement. There you'll find dead Karen. Take the Surgery Key hanging on the wall. Then open the drawer of the desk to find a Prescription. Examine the Prescription to learn written text on the back: "A pair of raindrops fell from the sky. As they landed on the ground, a child was born..." Get to the 2nd floor and enter the Surgery Room using the key. You'll find another dead body there. Take out the Scalpel from his leg. Exit and go to the middle Patient Room. Notice that the bed's mattress a bit torn up. Use the Scalpel on the bed to get a Quarter. Exit the room and notice a wending machine with a sticker "1 dollar" in the end of the corridor. Now you can go to the Waiting Room on the 1st floor (the one with the symbol). Examine the 2nd chair on the left to get the Chair Leg. Touch the symbol to switch to the Otherworld. Go to the 2nd floor and enter the left Patient Room. Use the scalpel to get a Quarter from the sticky mess on the chair. Then use the Chair Leg to get some of that substance on its tip. You can enter the other two Patient Rooms to get a First-Aid Kit and Handgun Ammo. You can always get them there when you'll need. Get to the 1st floor and find the picture on the wall. Now it's a skin with dried blood on it. Use the Scalpel to carve in it. If you remember, the text on the painting in Real World said: "This is the path to God". You should carve this path in this way:
Go to the Otherworld. Go to the Patient Rooms on the 2nd floor if you're out of Ammo and First-Aid Kits - you'll need them. Then get to the Basement. Go south and the voice will speak once again:
Go forward the wall with a face and the dialogue will start:
Shoot Lucas. After the battle get the Iron Key from the ground. Return to the Normal World and unlock the last lock on the door with tree locks. Enter the door. You will find yourself in a dark room with a chair and some moving creature. The final dialogue will start:
To be continued...