Working the night shift in Animal Hospital means more than treating patients. Some of the animals lining up at your reception window are anomalies pretending to be customers, and letting one slip inside drains your Sanity and can kill the patient you are supposed to be helping. Spotting them fast is the whole job.
Quick answer: Catch an anomaly at the window and press the big red button to close the shutters so it leaves. If one already checked in, hit it with a gun or taser (a taser also gives +2 Sanity), and calm a head-banging patient by handing it coffee.
How anomalies work in Animal Hospital
Each shift hands you a set number of patients, and a random number of anomalies mixed in. There are 15+ of them in total. Some spawn directly inside the hospital as monsters or ghosts, while others walk up to the reception desk disguised as ordinary patients or visitors. Both types can attack you, drain your Sanity meter, or kill a patient if you are slow to react.
The reliable routine is simple. When a patient arrives, stamp their details and take a photo, then flip to the CCTV cameras while the photo develops. Check them on the cameras, go back and read the finished photo, and only proceed if everything looks clean. Keeping a taser and coffee in your inventory saves you from sprinting back to reception when something goes wrong across the building.
Anomalies you can spot at the reception window
These give themselves away by appearance alone. A single careful look at the window is usually enough to deny them service.
| Sign | What it means |
|---|---|
| Hollow eyes | Completely empty eyes; can cause the Death Ritual if let inside. |
| Human teeth | Acts normal but has human-like teeth; can trigger the Death Ritual or turn into a Shapeshifter. |
| Creepy smile | Wide eyes and an unnatural grin; also causes the Death Ritual or becomes a Shapeshifter. |
| Three eyes | Three hollow eyes glowing red; can spawn monsters that attack patients. |
| Googly eyes and sharp teeth | Strange eyes, a terrifying smile, and a distorted voice. |
| Twitching | Watch for a few seconds; repeated head or arm twitches confirm an anomaly. |
| Head Banger | Bangs its head on the glass until it cracks. Harmless if ignored, but interacting without coffee costs Sanity. |
Anomalies you can only catch in the photo
Some visitors look perfectly normal at the window and only reveal themselves once their photo finishes developing. Always wait for the picture to process fully before you judge it.
| Photo tell | What to check |
|---|---|
| Different appearance | The ears, eyes, color, or shape look different in the photo than at the window. |
| Static on the photo | Any static effect marks an anomaly; it can appear alongside a changed appearance. |
| Cursed photo | Examining one mid-processing instantly costs 10 Sanity. A fully processed cursed photo shows an unnatural animal. |
Anomalies you can only see on the CCTV cameras
A handful of anomalies look fine at the window and in their photo. They only break character on the surveillance feeds, so cycle through the cameras regularly. A Skinwalker, for example, only shows its wide, sharp-toothed mouth when it is standing at the reception window, so use the waiting area camera to catch it.
| Camera tell | What to check |
|---|---|
| Deformed body | The body looks distorted on camera and changes each time you switch feeds. |
| Void body | A completely black, hollow body seen through the reception camera. |
| Twitching | Looks normal in person but twitches on the footage. |
| Skinwalker / Shapeshifter | A wide mouth full of sharp teeth appears only on camera. |
| Different ears | The ears look different through the cameras than in person. |
| Staring at the cameras | The animal stares straight into the security cams whenever you check. |
| Black eyes | A black bar over the face with realistic eyes underneath. |
| Black body with red eyes | Click Exit fast or the camera zooms in and drains Sanity; repair that camera afterward. |
Hazard anomalies that appear inside the hospital
Not every threat lines up at the desk. These show up around the building while you work, and each one demands a specific response rather than a shutter close.
| Hazard | How to handle it |
|---|---|
| Flesh Ceiling | A blob of flesh with eyeballs drips from the ceiling. Avoid eye contact and treat the patient; it leaves when they do. |
| Translucent Man | A body blends into a room’s tiles. Do not stare at the eyes, or it chases you. Run to the lobby to lose it. |
| Skinwalker | A copy of a patient you have already seen. Taser it, or hold E to pull it off its victim; spam E to fight back if attacked. |
| Monster Under The Bed | Red eyes and black hands under a bed with a red line on the floor. Avoid the line, hop over the bed, and treat the patient. |
| The Stalker | A towering shadow bunny peeking around corners. Avoid eye contact; looking costs 10 Sanity. |
| Demon cat jumpscare | Only visible on cams at the end of a hallway. Unavoidable if you are on cameras; costs 20 Sanity. |
| Death Ritual | A patient floats over the bed in red light. Beat the timer, reach the room, and remove every candle (each one costs Sanity). |
| Tendril Surgery | Purple tendrils sprout from a patient on the table. Complete the surgery mini-game to remove them. |
| Slime | Green slime trails from a passing patient. Interact with each glob to clean it up. |
| Fire | An empty room catches fire. Grab the extinguisher by the shop doors and put it out. |
How to get rid of an anomaly
The easiest and safest method is denying service. If you spot an anomaly while it is still at the reception window, press the big red button to close the shutters, and it walks off after a few seconds.
If an anomaly has already finished check-in, you have two options. Use a gun or taser on it, keeping in mind that a taser also restores +2 Sanity. Alternatively, complete the diagnosis and give it the wrong medicine to kill it, though this lowers your end-of-shift rewards.
The Head Banger is the one exception
The Head Banger, sometimes seen as a purple bear-like patient smacking its head on the glass, blocks the shutters from closing. To move it along, either wait for it to tire out and leave, or give it coffee.
[E] Coffee to brew a cup. A prompt confirms you make yourself a coffee.[E] Ask to Leave prompt. The patient drinks the coffee, calms down, and walks off down the hallway.
You will know each removal worked by the same cues every time. Shutters send window anomalies away after a few seconds, a taser or gun drops an anomaly on the spot, hazards clear once their required action is done, and the Head Banger physically turns and leaves after taking the coffee. Keep your inventory stocked and cycle photo and camera checks on every patient, and the night shift stays under control.
