Hospital Escape

The Hospital Escape describes Venom Snake's flight out of Dhekelia SBA Memorial Hospital while it was attacked by XOF forces in an attempt to kill Big Boss.

Prelude
On March 16, 1975, the Militaires Sans Frontières was attacked by XOF and wiped out, with Big Boss being believed to have been deceased. In actuality, he survived, albeit under critical condition. He fell into a nine-year coma and eventually awoke in February of 1984. After waking up he was greeted by Ocelot who had been watching over him anticipating his awakening. Ocelot informed him of Zero's plan (to have the medic from the crashed chopper act as a body double for him) as well several other developments which had come to light during his coma, including Volgin's survival, the fate of the Enfants Terribles project and his clones, the birth of the war economy and Zero's infection, disappearance and subsequent commissioning of the creation of an AI network to succeed him as the head of Cipher.

Big Boss made a fast recovery and one of his first actions after getting back on his feet was to go for a smoke. When Ocelot found him outside the ward (which was a non smoking one) he informed him that the XOF had found out about him waking up, adding that "the man on fire" had chosen that time to wake up as well. These events meant that they would need to speed up their plan and wake up Big Boss's double right away. Big Boss showed apprehension about having somebody else assume his identity against their will but he nevertheless ended up being talked around to the idea by Ocelot, realising that it was necessary to ensure his own survival, and that it is what the medic would have wanted. With that said they agreed to wake him up right away and act as his bodyguard under the guise of Ishmael, to ensure that he escaped the hospital alive and returned to full health.

"Awakening"
On February 26, 1984, Venom Snake was woken up from his coma. A nurse, Alexandra Pikrammenos, was making her rounds when Venom Snake's movements caught her attention. She approached him and asked if he could hear her. When she realized that he did, she ran to get Evangelos Constantinou, M.D.

On March 1, Pikrammenos returned with Constantinou, who, after conducting some basic motor tests to see if he's functional, told Venom Snake that he had been in a nine year coma. This, however, caused Venom Snake to go into shock, forcing the doctor and nurse to sedate him. On March 8, he regained enough consciousness to follow Constantinou explaining that nine years prior, Venom Snake had suffered various injuries which included 108 fragments of shrapnel and human matter (bones and teeth), with a huge chunk being situated on his cerebral cortex. Constantinou also implied that Venom Snake's left arm was lost in the accident, with Venom Snake going into shock again after verifying that he had indeed lost his arm, forcing the nurse and doctor to sedate him again.

On March 11, Constantinou verified that the hospital had been infiltrated by people planning to kill Venom Snake, and that he needed to be put through plastic surgery to hide his identity. The doctor then showed Venom Snake his reflection, and explained that he had healed up "pretty well", before admitting that the bandages were actually intended to mask his identity. The doctor also gave Snake the identity of Ahab to keep his identity hidden.

While he was explaining this, a female assassin managed to stealthily place a garrote on Pikrammenos and kill her, before proceeding to kill Constantinou. After the deed was done, she then called in to an unknown employer and relayed that she had not killed Venom Snake yet, as the patient lying in the bed next to him, Ishmael, had seen her face. She then stated that her employer can "consider it done" before moving at Snake with a knife as he is struggling to get to the discarded handgun the doctor originally had. She then picked up the handgun and readied it at Snake, but was then jumped by the other patient, Ishmael, who grabbed hold of her from behind and placed her in a chokehold. She eventually freed herself, knocking over a tray of medical supplies and tossing him near a wall.

The patient then tried to throw several objects that fell from the tray at her, eventually throwing a flask of rubbing alcohol at her, which shattered against her forearm while countering. She then threw her knife at the patient, hitting his left shoulder, and then proceeded towards Venom Snake and strangled him. However, before she could finish the job, she was suddenly set on fire, forcing her to let go and flee to a window, but then she crawled over to Snake, just as Ishmael removed the knife from his shoulder and threw it back at her, and then threw another bottle of rubbing alcohol at her, intensifying the flames, and forcing her to jump out of the window.

"Time to Go"
Venom Snake noticed that his left arm was missing and a basic hook like prosthetic arm was in its place. He was later approached by Ishmael. The patient then explained that he gave the assassin a "light" and that she "took the short way down." When asked about his identity, he cryptically stated "you're talking to yourself", claiming to have watched Venom Snake during his nine year coma and asked to be called Ishmael. He told Venom Snake that the world wanted him dead. After a rumble, Ishmael gave Venom Snake a digoxin injection to help him walk. They then proceeded to leave at 02:03am.

Ishmael then proceeded to make sure the coast was clear before having himself and Venom Snake leave the room, making sure a chopper was out of sight from a nearby window. Ishmael had initially planned on taking the stairs to evacuate, but due to the digoxin taking too long to meet the effect for Venom Snake, he was forced to change plans and head for the elevator. They were just about to arrive at the elevator, only to discover a mysterious gas-mask wearing child at the area. In addition, the elevator suddenly burst into flames and out burst a man on fire. However, the man shortly after the fire sprinklers went off disapparated. Unable to use the elevator, Ishmael and Venom Snake went back the way they came. By this time, Venom Snake managed to regain the ability to walk.

Before they could cross over, however, they were forced to hide from a helicopter, with Ishmael also forcing Venom Snake down when the latter came close to being discovered. He then noticed that Venom Snake's arm was broken from the earlier encounter with the Man on Fire, offering to help by relocating the arm, telling Venom Snake that next time he should do it himself, as mending one's wounds is integral to surviving against enemies. They then saw another helicopter dropping off some soldiers via fast rope, as well as a discarded smoke grenade. Realizing the implications of this, Ishmael had Venom Snake duck into a nearby patient holding room, with Venom Snake following another patient before being grabbed by Ishmael and made to hide underneath one of the beds. While hiding, an XOF soldier proceeded to murder two patients, inside the room, execution style.

Upon leaving the room after Ishmael gave the go-ahead, Venom Snake and Ishmael witnessed a nurse and another patient requesting help from a chopper, only to learn the hard way the occupants weren't interested in leaving witnesses. The duo then proceeded to avoid the searchlights per Ishmael's command. One patient ended up being killed by one of the soldiers. Eventually, Ishmael and Venom Snake proceeded to duck into a stairwell alongside a patient, with the former proceeding to barricade the door with a row of lockers. However, they then discovered that the soldiers are trying to use a welding torch to break through. Ishmael and Venom Snake were then forced to descend down the stairs. Unfortunately for the patient, he went upstairs right into the path of some soldiers and was gunned down. Although Ishmael intended to go down the stairs fully, he was forced to turn back due to it "being ugly down there," telling Venom Snake to do the same.

They then went into a hallway filled with a large amount of patients and nurses who are confused and terrified of what was going on, who are then promptly caught in a massacre on both sides of the hall, with Venom Snake nearly being killed, with Ishmael being the only reason Venom Snake lived by grabbing him and throwing him into another room. Ishmael and Venom Snake then proceeded to hide between two different sides of the room behind various curtains, while several soldiers proceeded to try and hunt them down. They ultimately only managed to kill some patients, with Venom Snake and Ishmael evading the patrols entirely. Ishmael then briefly followed the soldiers and overheard that although they didn't find anything, they are to continue searching. Knowing that they can't go through while there were still soldiers nearby, Ishmael and Venom Snake then proceeded to pretend that they were among the recently deceased nurses and patients in the adjoining hallway in an attempt to deter pursuit.

As the various soldiers commenced their searches, they also shot rounds into the corpses to ensure they were dead. Ishmael's ploy almost worked, but he accidentally leaked an IV bag, which eventually got a guard to notice, and also spoiled Venom Snake's attempt to hide due to instinctively attempting to block out the flashlight on his face. However, the child from before proceeded to apparate and disapparate, distracting the soldier. In addition, the Man on Fire reappeared again. The soldiers then attempted to fend it off, only for the Man on Fire to withstand several of their attacks, even setting one of the soldiers alight and forcing him to jump through a window. Eventually, the Man on Fire sent a hail of bullets in their direction, also dislocating Venom Snake's leg. A chopper then arrived and attempted to destroy the Man on Fire. However, the most the missiles were able to do was destroy his overcoat. The Man on Fire then proceeded to fire a blast at the chopper, severely damaging it and causing it to crash land.

It then pursued Ishmael and Venom Snake (who had capitalized on the distraction the chopper had unwittingly provided for them), the latter limping from his earlier injury. Ishmael then attempted to use a handgun he had stolen from one of the soldiers on the Man on Fire, only for him to absorb the bullets. Ishmael then noticed a sprinkler system and then proceeded to shoot it out, causing it to drench the Man on Fire and force him to retreat yet again. Upon noticing that Venom Snake was injured, Ishmael told Venom Snake to treat his injury first. Venom Snake then proceeded to relocate his leg, fixing it. With no other options left, Ishmael decided to take the stairs down. Ishmael then proceeded to go into a hallway, also shooting a patrolling soldier, before finding a discarded handgun and discarding a magazine and adjusting the gun before refilling. He then proceeded to give the discarded handgun to Venom Snake, especially after the room managed to catch fire, so Snake could defend himself.

Venom Snake then proceeded to fire the gun at a fire extinguisher to halt the blaze somewhat, and then alongside Ishmael proceeded to shoot some soldiers nearby. Upon arriving at the main lobby, Ishmael, noticing the heavy enemy presence in there, decided to cause a distraction by throwing away his silencer as well as shooting at the guards. Ishmael then left the premises to search for an appropriate escape vehicle, although Venom Snake was prevented from escaping himself by the child from earlier, who used psychokinesis to block the door, as well as the Man on Fire taking out the soldiers.

Eventually, a tank managed to destroy the rubble, with soldiers following in behind it, firing on the Man on Fire, although one of the pieces of rubble, the remains of a helicopter, suddenly became active and chopped up several of the soldiers. The tank then drove in and fired at the Man on Fire, who survived the blast before being run over by the tank. Seeing the opportunity to escape, Venom Snake then proceeded to leave, but then a shockwave occurred from the Man on Fire, destroying the tank and knocking Venom Snake back. Venom Snake then futilely attempted to defend himself against the Man on Fire, although he was saved at the last minute when an ambulance ran over the Man on Fire, with Ishmael, who was driving the vehicle, telling Snake to get in.

They then escaped the hospital, also trying to avoid various fire trucks and other emergency vehicles, as well as various meteoric objects that were presumably remains of the hospital thrown by the Man on Fire, although one of the impacts knocked out Ishmael, forcing Venom Snake to take over the wheel. They then had to evade a helicopter via a tunnel, although a roadblock forced them to crash and leave the vehicle upturned.

Return of Ocelot
The vehicle eventually ended up in the suburbs of Xylotymvou near the area of the base hospital. At 02:32, Ishmael regained consciousness inside the vehicle. He then tried to reach for something, only to be dragged out by Ocelot. Ocelot then told him to follow him and hurry, while also calling him Big Boss. Ishmael then left, although not before getting one last look at the vehicle and Snake's trapped body. Venom Snake then awoke at 03:07 only to find Ishmael gone. He then undid his seatbelt only to fall down onto the roof and crawled out of the windshield. However, he then finds himself face to face with the child, who then summons a giant whale made out of fire, which proceeded to consume the chopper nearby. The flames then form to reveal the child and the Man on Fire present atop of a demonic flaming unicorn. Snake then tries to run, only to be rescued by Ocelot atop a horse, the latter telling him that he's his ally.

Ocelot, who had been responsible for hiding Snake at the hospital in the first place, then supplied Snake with a shotgun, telling him to slow down the pursuing fiery entity. While fleeing, Ocelot expressed annoyance at the Man on Fire being persistent in his pursuit, only to then recognize him as being someone who was supposed to have died. They ultimately managed to evade them, although a nearby lightning strike resulted in the bridge collapsing and Ocelot, Snake, and Ocelot's horse falling into the water. Both survived, and the two escaped the area.

As Ocelot helped them along, however, the child and the Man on Fire watched in the distance before disappearing. Ocelot then introduced himself before stating he remembered him while identifying Venom Snake as Big Boss. He then explained that a certain individual had sent him with two objectives: Rescue Venom Snake, and then save the man who hired him to do the job: Kazuhira Miller. After relaying what had happened nine years before, Ocelot told Venom Snake that Miller was being held in Afghanistan.

Venom Snake was confused, and Ocelot, after joking that his comatose state had him missing out on current events, proceeded to explain that the Soviets had invaded the country and was fighting the Muslim populace, the latter being backed by the Americans. Miller had been training the Mujahideen when he had been captured by the Soviet forces, more specifically the 40th Army. Ocelot then explained that Miller had started being transferred by the squad holding him the day before the hospital attack, he's got three days before they reach the Soviet garrison, and he'd be interrogated for a few more days before he was either sent to a lager or left to rot in an Afghani ditch. Ocelot estimated that Miller had two weeks at best under Soviet torture. He explained that the job itself didn't really mean much to Miller so much as try to keep Venom Snake safe. They then got to a whaling ship, with Ocelot explaining that he got a good deal on the ship after the IWC "started raising a stink", which would act as their ticket to Afghanistan. Finally, he explaind that they've got seven days to get to Port Qasim and another three for the trek on land.

Before departing, however, Ocelot needed to take care of something first: On 05:59 at Western Ormideia, near the ruins of the bridge, Ocelot reconvened with Big Boss and told him to use the motorcycle, assuring him that it's all tuned up and ready to go and that he'd handle the rest. He then gave Big Boss a passport with a faked identity, also suggesting that he change his face as well to ensure he couldn't be identified. He explained that Venom Snake would take his place, and would believe he was Big Boss as well, with Big Boss summing it up as being his own phantom. Finally, Ocelot explained that the whole world wanted Big Boss's head, and assured him that Snake could handle it before telling him to leave. However, before Big Boss did so, he had to smoke a cigar, with Ocelot lighting it. He then left, although not before promising that they would meet again.

Ocelot then returned to the whaling ship transport and reconvened with Venom Snake, with it setting off. While on the way there, Ocelot brought over a new prosthetic for him.

Behind the scenes
"Facts do not exist, there are only interpretations."

- Friedrich Nietzsche, opening quote for "Truth - The Man Who Sold the World"

This event was the basis for the "Prologue: Awakening" chapter as well as "Chapter 46: Truth: The Man Who Sold the World." The latter chapter is largely similar to the former, except for some distinct differences: First, the player can understand some of the Greek language the personnel and to some extent patients were speaking, second, the player's customized face is shown instead of Big Boss's face when the doctor shows the patient's reflection, third, the medic is revealed to be the soldier Constantinou hid when showing two group photos featuring Morpho, Miller, Big Boss, the medic, and a random MSF soldier, and fourth, the chapter ends with the ambulance crash, instead of at the bridge, as it's revealed that Ishmael was the real Big Boss, instead of Venom Snake.

The opening of the "Truth" chapter features a quote from Friedrich Nietzsche about how facts don't exist, and that the only things that do are interpretations. This isn't the first time Metal Gear alluded to the works of Nietzsche, as the Piggyback Guide for Metal Gear Solid 3: Snake Eater inferred that the entirety of the Metal Gear series' theme was ultimately derived from Friedrich Nietzsche's "The Eternity of the Same."

According to Hideo Kojima's notes in the Piggyback Collector's Edition Guide's art gallery, the hospital escape in Cyprus was meant to show how MGS establishes cinematic drama within an action game, comparing it to the style found in linear games. He also elaborated that the prologue serves to remind the player of the gaming experience in previous MGS episodes, and quickly have it evolve into something new, comparing Snake's crawling, crouching, and eventual standing to the theory of Man's evolution. Fittingly, this coincides with Sahelanthropus's theme of evolving from the usual hunched-over stance of most Metal Gears to standing upwards, like the species it's named after.