After entering the Forbidden Woods, Patches will replace any NPC in a red-lantern home/window in the Frontier or Yharnam areas. Speaking with him will grant the Tonsil Stone , which reveals the Lesser Amygdala and allows you to be transported by the Lesser Amygdala in Cathedral Ward, near the entrance to Yahar’gul, Unseen Village, to the Lecture Building 1F.
After reaching the Lecture Building 1F:
Patches will reside in the room across from the Lecture Building 1F lamp and can be spoken to through the door, but he won’t say much. If you continue to the Nightmare Frontier and make your way to the treasure overlooking the swamp alley, past the Giant Lost Childs, a cutscene will occur in which Patches knocks you into the pit below.
After being knocked down in the Nightmare Frontier:
Head to the Lecture Building 2F, accessed by examining the mummy after beating The One Reborn, and take the ladder near the Church Giant to speak with Patches face-to-face for the Beg for Life gesture.
If you select “Not at All” Patches will hand over the Anti-Clockwise Metamorphosis Rune and will appear in the Chalice Dungeons as a merchant.
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