When Doctor Silas Clay arrived in Port Charles, he considered himself to be a single man although he had been married to Nina Reeves for over twenty years. When the truth about Silas' marital status was revealed by Detective Nathan West, Silas explained that his wife Nina had been in a coma for over twenty years after she had been injected with an overdose of a prescription medication. Nina's mother Madeline lied to both Silas and Nathan and informed them that Nina had passed away. Madeline later confessed to causing the overdose.
Nathan was revealed to be Nina's younger brother and he and Silas mourned Nina's passing. Meanwhile, Nina quietly emerged from her coma and worked to regain her strength so she could return to her life with Silas. She located Silas in Port Charles and was thrilled to discover that he had neither filed for a divorce nor married his former lover Ava Jerome. Without warning, Nina showed up in town and surprised Silas. She immediately moved into his apartment and assumed that her life would pick up where it had left off over twenty years ago.
Instead, Nina learned that her mother had caused her overdose in a successful attempt to cause her to lose Silas' child. Then, her younger brother James paid her a visit and explained that he went by the name Nathan West and that he was actually her cousin. The painful revelations continued as Silas shared that he had a daughter with Ava named Kiki and that he was involved in a romantic relationship with Sam Morgan. Even though Silas was involved with Sam, he allowed Nina to reside with him while she regained her strength and adjusted to life after the coma.
Unbeknownst to everyone around Nina except for her nurse Rosalie, Nina was not wheelchair bound as she claimed to be nor was she without money. Nina hoped to exact revenge on a slew of Port Charles residents, including Silas, Sam, and Kiki and she used the guise of being physically weak and without money as a way to remain dependent on her husband. When Silas's nephew Rafe overheard Nina admit her devious intentions, Nina gave him money to escape town and goaded him to leave before everyone learned that he used drugs and had caused an accident which killed an infant. After Rafe was involved in a car accident and declared brain-dead, Nina was relieved that her secrets would not be revealed and she used the tragedy to grow closer to Silas.
After Rafe’s death, Nina led Sam to believe that Silas had broken her trust and the couple broke up as Nina had hoped. She consoled Silas and repeatedly reminded him that she was his wife and would stand by him. Meanwhile, Nina admitted to Rosalie that she wanted Silas to give her a baby to make up for the child they had lost. In order to move the new plan along, Nina drugged Silas and they kissed. Although Silas did not sleep with Nina as she had hoped, Sam witnessed the amorous moment and Silas and Sam were driven farther apart.
Nina continued to grow closer to Silas while she developed a friendship with Franco. She revealed to Franco that she could walk and their bond deepened. Soon after, Nina’s relationship with Silas became intimate and she announced her desire to have his child. She refused to accept the diagnosis that she could not conceive and continued to make plans for a future with a baby.