Inside Exam Room 4 of the Otherworld Brookhaven Hospital, you'll find a puzzle called the Surgical Chair puzzle, which James will mark on his map. You'll need a few items in order to complete the puzzle, including one just nearby. Here's how to complete the Surgical Chair puzzle in the Silent Hill 2 remake.
Where To Find The Instrument of Force
Very near the Surgical Chair, find the Instrument of Force and pick it up. Use the Instrument of Force on the mannequin in the Surgical Chair, breaking its arm. The mannequin will then indicate that it's missing something in its eye, prompting you to look for it.
Where To Find the Key of Bliss
Head down the ladder from D1 into the Kitchen, watching out for the enemies around here. Go through the Cafeteria and into Medical Records, then find the hole in the wall. Slip through it to grab the Key of Bliss.
How To Solve The Surgical Chair Puzzle
Now, head back up the ladder in the Kitchen and back to the Surgical Chair. Using the Key of Bliss on its eye will net you the Lapis Eye Key. This key unlocks the center key-shaped lock on the Chained Box puzzle, but don't head back quite yet. Next up, you'll need to find and complete the Treatment Stretcher puzzle to find the next code.