Here's a full Brookhaven Hospital Otherworld walkthrough for the Silent Hill 2 remake. See how to pass through the Lady of the Door, other puzzle solutions, and all Otherworld Hospital maps!

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Brookhaven Hospital	South Vale Otherworld

Brookhaven Hospital Otherworld Walkthrough

• Locate the Chained Box
• Find the Keypad Code
• Find the Combination Lock Code
• Find the Lapis Eye Key
• Solve the Chained Box Puzzle
• Find the Lady of the Door's Rings
• Run From Pyramid Head
• Leave Brookhaven Hospital Otherworld

Locate the Chained Box

Once James comes into consciousness, he will be in the Brookhaven Hospital Otherworld. The map used to navigate this place will be named the Brookhaven Hospital Map, though the building's layout will be different. Open the doors into the Dayroom and head down to the hallway where you can find a save point to your left.

Walk toward the elevator and head over to the second floor. Upon exiting, you will immediately see a Chained Box covered under a white cloth which you will need to solve in order to progress the area. There will also be a save point on the wall behind it for your usage.

Hospital Box Code (Chained Box) Guide

Find the Keypad Code

Make your way toward the Laundry Room by walking down the east wing hall of the hospital, and break through the wall. Push the cabinet blocking the entrance to Room L2, wheel the laundry cart inside up against the wall to Room L3, and access the small space. Walk across to the Observation Room where you can find the Director's Office Key on top of a book in front of a TV.

Head back into the hallway and open the Director's Office. Climb up the ladder to the third floor where you will find a Treatment Stretcher to your left. To power it on, navigate your way toward the Generator by following the red wire on the floor and into an unnamed room beside the elevator. Activate the generator, return to the Treatment Stretcher, and turn it on to reveal the Keypad Code: 9659.

Find the Combination Lock Code

Head to the second floor Restroom, in front of the Laundry Room, and cross into Room L1 through a gap in the wall. Go to Room M1 to fix the bent hospital clock hand, then break the wall in Room M3 to access Room M2. Grab the Calendar Page, count the pills in the sink, and watch the lights flicker through a hole in the wall.

Return to the clock, set the hand to 2:00, and prepare for enemies after alarms ring. Use the Calendar Page as a clue to solve the Combination Lock Code based on the pills, hospital clock, and the number of times the light went dark which gives you the code: 1622.

Find the Lapis Eye Key

Walk to the Women's Locker Room by crawling through a small space from the Nurse's Lounge. Make your way to the stairwell, climb to the third floor, and head into Exam Room 4. Pick up the Instrument of Force on the instrument table and use it on the Medical Dummy's left arm. Afterward, head to Room D2's northern exterior wall and break through to access a ladder leading down to the first floor Pantry.

From there, pass through the Cafeteria and Storage Room until you reach an unnamed area beside the Restroom where you can collect a Key of Bliss. Return to the Surgical Chair on the third floor via the pantry ladder and use the Key of Bliss on the Medical Dummy's left eye to get the Lapis Eye Key.

Lapis Eye Key Location and How to Use

Solve the Chained Box Puzzle

Return to the Chained Box Puzzle and input the Keypad Code, Combination Lock Code, and finally unlock the box with the Lapis Eye Key. James will find that the box is empty, though a curtain drops from behind him revealing a statue with the -1 Elevator Button in its mouth. To progress further, you will need to insert rings on the Lady of the Door's fingers.

Find the Lady of the Door's Rings

Head to the second floor elevator and insert the -1 Elevator Button to access the Basement. Before the elevator descends, a recording of the Trick or Treat quiz show will play, with the answers to it being 2, 3, and 1—you can keep these in mind for later. Once in the basement, head right and enter the Pump Room, where you'll find a Copper Ring on a table. Afterward, a cutscene will trigger, reuniting James with Maria.

Walk to the other side of the hallway and climb up the stairwell to the first floor, then head to the Doctor's Lounge by passing through the Pool and Shower Rooms. Open a refrigerator in the middle of the room to obtain a Lead Ring. With both rings in your possession, head back to the Lady of the Door on the second floor, and insert the rings into her fingers to open the door.

Optional: Open the Decorative Box in the Pharmacy

After obtaining the Lead Ring from the Doctor's lounge, you may optionally stop by the Pharmacy by passing through the Locker Rooms. Inside, you can find a Decorative Box on top of a table. Input the answers for the elevator quiz: 2-3-1 on each row to open the box. This rewards you with Shotgun Ammo and Syringes that you can use later on.

Decorative Box Code

Run From Pyramid Head

As you descend the stairs, find a save point on the first door you encounter, and continue downward until you reach the basement. Continue forward on the linear path until you reach a certain point where Pyramid Head appears through the same door you exited from.

In this encounter, he will be much more agile compared to previous instances, so do not attempt to fight him off. Instead, don't look back and keep your distance by running down the halls, because being hit by his spear will kill you instantly. A cutscene will play once you get close enough to the elevator, which results in Maria dying before James' eyes, leaving him alone in the elevator as it ascends.

Pyramid Head Boss Fight Guide

Leave Brookhaven Hospital Otherworld

Now on the first floor, make your way to the Lobby and find the Hospital Entrance Key inside the Reception Office where you may also find a save point. After picking up the key, James will see Laura outside the window, running away from the hospital. Make your way to the hospital's front door and exit Brookhaven Hospital into South Vale Otherworld.

South Vale Otherworld Walkthrough

Brookhaven Hospital Otherworld Maps

All Brookhaven Hospital Otherworld Maps

Basement	1F
2F	3F

All Map Locations Guide

Brookhaven Hospital Otherworld Puzzles

All Puzzles

Hospital Box Code Guide	Elevator Quiz Answers	Decorative Box

Silent Hill 2 Remake Related Guides

Story Walkthrough and All Chapters

All Story Chapters

Story Walkthrough Chapters
Eastern South Vale	Wood Side Apartments	Blue Creek Apartments
Western South Vale	Brookhaven Hospital	Brookhaven Hospital Otherworld
South Vale Otherworld	Historical Society	Toluca Prison
Labyrinth	Lakeview Hotel	Lakeview Hotel Otherworld