Rachel Adair first met Courtney Mathews on a flight from the Bahamas where Rachel lent a sympathetic ear as Courtney told her all about A.J. and the fight that had transpired in his hotel room. A few days later, Rachel showed up on Courtney's doorstep with the news that she killed A.J. for Courtney and in exchange she expected Courtney to kill Rachel's ex-lover, Steven Webber. Courtney flatly refused. Rachel then made it clear that Courtney didn't have the option to refuse. To ensure Courtney cooperated, Rachel manufactured evidence that could be used to convict Courtney. She threatened to turn it over to the police if Courtney didn't kill Steven. Things went from bad to worse for Courtney when Rachel took a job at General Hospital and moved in with Courtney. Courtney managed to put off killing Steven and made several attempt to talk some sense into Rachel. Rachel refused to listen and took the drastic step of administering a non-lethal dose of poison to Jax in order to prove to Courtney that she meant business.
Eventually it would be revealed that Rachel never murdered A.J. He was still very much alive and Rachel was working with him. Rachel's need for revenge was not as strong as A.J.'s and she decided to come clean to Courtney and Jax about everything. Unfortunately before she could tell them the truth over lunch at the Metro Court, Sonny's goons opened fire on one of Sonny's rivals and Rachel was shot. She was critically injured and lay in a coma for several weeks. When she woke up, she was immediately charged with A.J.'s murder. She tried to tell everyone that A.J. was not dead, but no one save Courtney would believe Rachel. Courtney happened to be in Rachel's hospital room when she heard A.J.'s voice on Rachel's cell phone. It would later be revealed that A.J.'s faked death had all been an elaborate ruse to draw suspicion away from him as being the mastermind behind the kidnapping of Sonny's three children. A.J. wanted to cause trouble for Courtney but more importantly he wanted to stage Michael Corinthos' death so he could take him away and raise his biological son without the risk of anyone looking for A.J. and Michael. Rachel was crushed when she realized that her lover had been using her. She had met A.J. on vacation and been swept off of her feet by him.
An outcast, Rachel continued to work at General Hospital. One night, she witnessed Dr. Thomas walk into A.J.'s hospital room at the time the coroner said A.J. was murdered. She made the mistake of revealing to Reese Marshall what she saw while Dr. Thomas was lurking behind a corner. Fearing Rachel's testimony could ruin his career and send him to jail, Dr. Thomas invited her to his office one night. He had a syringe and a mission. The next day Rachel's body would be found along with a suicide note confessing to the murder of A.J.