Leonardo has become one with Pyramid Head, he's aware he's got sins to pay for.

Perhaps Mary was right; she didn't deserve flowers, because roses symbolize true love which is something that he could not provide. And now between the carnage, the disease, and the drugs; Leonardo was the monster. He was always the monster.

Silent Hill is not even close to Hell, if anything. Silent Hill is the Purgatory, a personal Hell. Leonardo sees this his own way, and this is the luck of the draw; to live as a monster surrounded by his sexual urges for the rest of his life. The Nurses are fairly aggressive and if he encounters more than one in an area they would surround him like a group of teenage girls.

It's almost like they were drawn to him, shrieks and gurgles when approaching him; it is disturbing, could this be considered as harassment? It's not that he could complain, this is what he deserves.

But you're different from the rest...