It consists of a pretty straightforward fetch quest. The dead inmate has had his heart ripped out of his chest. The player must descend into the Sewer Labyrinth, which can be accessed by using a ladder close to the corpse, in order to retrieve the heart so it can be returned to its owner. There are two possible locations of the heart, depending on the difficulty. On easy, the heart can be found by using the forensic flashlight and following the tracks. However, on normal/hard, the user will have to take a different route; it can be quite hard to find, so below is a list of steps to take in order to retrieve the heart:
- From the ladder, go straight towards the end of the path.
- Turn left and go through the gate.
- Turn right.
- Go past the intersection ahead.
- At the second intersection, turn right.
- Continue until reaching a gate; open it and obtain the heart.
- Completing the sidequest unlocks the achievement/trophy "Telltale Heart". This name is a reference to a short horror story called "The Tell-Tale Heart", by Edgar Allan Poe. Similar to the story itself, while searching for the heart in the sewers, the beating will be heard all the way, accelerating as the player gets near.
- The prisoner's heart being ripped out of his chest may have been a reference on how Walter Sullivan removed the hearts of his first ten victims.
- The prisoner resembles Adam Shepherd from Silent Hill: Homecoming, and slightly Joseph Schreiber from Silent Hill 4: The Room.