The objective is a timed “check the area” task that only completes at night and only from a specific spot outside the building. Bring a flashlight in your inventory and arrive between 23:00 and 00:59. You do not need to enter the Sanatorium proper and you do not need to ring the bell for this step.
Stand on the road just outside the front gate, near the guard shack/security barrier. An interaction prompt appears on the road by the gate around the time window. Hold your position there with the flashlight, and the quest will register.
Where exactly to stand (and what to avoid)
Face the Sanatorium’s main gate from the road. The check trigger sits on the roadway near the security barrier/guard post just beyond the bell area. If you push inside the grounds, you risk spawning enemies prematurely and losing the interaction. Stay outside the gate on the road.
Common pitfall: ringing the bell at midnight during the investigation step can summon hostile ghosts that interrupt the check and get you killed. Save the bell for the follow-up ghost quest.
Ghosts at the Sanatorium (spawn timing and behavior)
For the ghost-hunting follow-up (e.g., quests that ask you to kill ghosts or collect samples), timing and the bell matter:
- Spawn window: around midnight. Players consistently trigger spawns between 23:40 and shortly after 00:00, with viable encounters observed through roughly 00:30. The broader Sanatorium “check” window is 23:00–00:59, but ghost density is highest near midnight.
- Bell usage: a single ring near midnight is more reliable than spamming. Ringing around 23:50 often leads to ghosts appearing as the clock rolls over to 00:00. If you ring too late after midnight, they may not spawn.
- Behavior: instead of immediately rushing the bell, ghosts can populate the grounds and even areas outside the walls. If they don’t come to you, sweep the perimeter, inside corridors, and the approach roads.
How to kill ghosts efficiently (weapons and ammo)
Ghosts are tanky against standard gunfire. Several setups work, but some are dramatically faster than others:
- Coin Sword: craftable via a blueprint sold by the blue trader (cost ~66,000). It hits for roughly 400–600+ per swing and can one‑shot ghosts. This is the cleanest option for the kill/collection step.
- Candy Gun: also effective versus ghosts; good if you don’t want to commit to melee.
- Conventional firearms: viable but ammo‑hungry due to high physical resistance. With top‑tier rounds (e.g., Advanced AP in heavy rifles), expect multiple shots per target. For example, an M107 with strong AP ammo can down a ghost in about 4–5 well‑placed shots.
Elemental guns don’t offer bonus damage in this encounter window. If you’re running pure firearms, bring extra ammo and prioritize headshots where possible.
Sanatorium Restaurant Key (Specific Medicine IV)
Later progression sends you back to the Sanatorium for a locked room objective tied to “Specific Medicine IV.” That room requires the Sanatorium Restaurant Key, even though some quest text doesn’t explicitly flag the requirement. Without the key, you can’t access the specific painkiller objective room.
Where to find the key: it’s a random spawn item. Players report finds across the game, including J‑Lab, Warehouse, Storm Area bunkers, and occasionally via the Black Market. Check locked rooms with safes and cabinets and search hanging jackets on walls; those spawn points commonly produce keys of all types. Because it’s random, plan for multiple raids.
Fast extraction after the Sanatorium
If you’re finishing late in the window or after a ghost fight, consider exiting via the Hidden Mines to the east of the Sanatorium. It’s a straightforward way out without crossing the entire zone again.
Timing and triggers cheat sheet
| Task | When it works | Where to stand | Trigger/Action | Notes |
|---|---|---|---|---|
| Strange Sanatorium (investigate) | 23:00–00:59 | Road by the front gate, near security barrier | Hold flashlight, wait for interaction prompt | Do not ring the bell; stay outside the gate |
| Ghost spawns (kill/collect quests) | ~23:40–00:30 focus on midnight | Start at the bell, then sweep grounds | Ring bell once near 23:50–00:00 | Ghosts may roam; patrol inside/outside walls |
| Ghost combat (efficient) | Any | — | Use Coin Sword or Candy Gun | Firearms work but consume lots of ammo |
| Specific Medicine IV (locked room) | Any | Sanatorium restaurant area | Requires Sanatorium Restaurant Key | Key is random; check J‑Lab, Warehouse, bunkers, jackets |
If the interaction won’t pop at the gate, verify the time and the flashlight, then reposition slightly along the road by the barrier until the button appears. If ghosts don’t show for the later quest, arrive earlier, ring once near midnight, and fan out—some runs place them deeper in the building or along the approach roads.
