Nurse Birch worked for Dr. Emil Hartman at the Cauldron Lake Lodge as a male nurse who helped deal with unruly patients. He was a burly man built like a wrestler, and restrained Alan Wake shortly after he resisted admittance to the institute.
When Wake's agent, Barry Wheeler, came to the lodge searching for Wake, Hartman admitted him to the main area, where Birch snuck up behind the agent. When Barry demanded to know where Wake was, Birch grabbed him, and together with another orderly, the two beat him unconscious. Under Hartman's orders, they locked him in an office of the institution's staff wing.
Nurse Birch follows Alan and Hartman around when Dr. Hartman tries to convince Alan that he's been dreaming making sure Alan doesn't "have another violent episode". Wake refers to Birch as 'Hartman's Pet Gorilla', and, apparently remembered dealing with Birch the last time he tried to attack Hartman at the lodge, because he stated he would remain calm due to this. While the doctor took his patient from room to room to show him the grounds, Birch followed behind, locking all the doors after they had passed through them. After Hartman walks away to fix the fuse box, Birch encourages Alan to go upstairs and continue writing, as Hartman suggests. The beefy orderly takes him back to his room when the Dark Presence sends a storm to the lodge, causing the power to flicker briefly. Later on, when the Anderson Brothers break free and attack Nurse Sinclair, Birch arrived to deal with them. The Andersons threatened him with a plastic hammer, a fact the hulking Birch easily ignored until it mysteriously turned into a real one, possibly as an effect of Wake's writing their escape from the Lodge into the story. Birch was astonished, and demanded, "Where the hell did they get a damn hammer?" a statement which suggested he was having trouble believing the hammer had almost literally appeared out of thin air. Birch and Nurse Sinclair tried to give the brothers a sedative, but they bashed Sinclair in the head with a hammer. After Tor charged him, Birch fled and hid in a storage closet. The Andersons then spent the next few minutes taunting him and demanding that the nurse come out and 'face the music'. Birch at first glared at them through the small window in the closet, witnessing Alan's escape as Wake stole the keys to the staff wing of the Lodge from the unconscious Sinclair. He was then inevitably engulfed by the Dark Presence and turned into a Taken.
Consumed by the Dark Presence, he disappeared from the Lodge and resurfaced when the darkness concentrated itself on stopping Wake's escape through the gardens just outside the structure. Asked by Barry Wheeler, who had also managed to escape the building, to go through Hartman's hedge maze and reach the parking lot, Alan stumbled through it, now attacked by Taken hunters from the surrounding area near Cauldron Lake. The possessed Birch also appeared out of darkness at the courtyard near the end of the hedge maze, placed there to stop the writer from proceeding. He stalked Wake through the remainder of the maze with a large axe, lurking atop the maze and jumping from hedge to hedge. Birch kept this up for a few minutes before finally attacking Alan near the gazebo. Leaking shadows as thick as the night itself, Nurse Birch proved a formidable foe. He was covered so thickly in the living blackness that Wake had trouble distinguishing whom he had been, other than a man-shaped shadow which had solidified in front of him.
After shining the flashlight on Birch, Wake recognized the hulking orderly. He engaged the creature in a quick duel while fending off dozens of Taken ravens, before Wake was finally forced to kill Birch with a shot from his pistol. He felt no regrets for having destroyed the possessed man in his own defense, since he had been one of Dr. Hartman's goons and Wake correctly recognized the thing wearing a familiar face only had been Birch, and was no longer really him.
Birch is much stronger than most Taken. The orderly has been covered so thickly in darkness that an extra shield of shadows has formed around him and the regular flashlight will wear his shield down very slowly. And adding to the trouble, you're going to be fighting a flock of Taken Birds while you're at it. Luckily, there are flares scattered around the hedge maze. If you picked up a few and the birds are distracting you and knocking your health down, make sure to use your flare to get some cover while you wear his shield away. Birch moves slowly at times but will pick up speed quickly when he is close. He is very powerful due to his incredible strength and can kill you in one swing if the birds have been doing some damage, and two hits if your health is full.
The player can also trap Birch in a corner, using one of the various flares in the maze to eat away at his shadows, allowing one to fend off some of the Ravens and Taken that are in the area. Repeat this until Birch's shadows are gone, and gun him down.
Another strategy is to avoid Birch altogether, and slowly cut down his shadows while dodging the other Taken, and kill one of the other Taken only when one has to. Once Birch's shadows are gone, kill him quickly, before the other Taken swarm the player.
There is also a First Aid box that you can use that has flare gun rounds and a flare gun, but you should not use this on Birch. Instead, shoot it up at the birds and kill them quickly, or just shoot it up into the sky to get some cover. You do not have to kill the birds first but it is recommended. While you are trimming down Birch's shadows with a flashlight, they can swoop down and knock your aim off, allowing Birch to finish you off in a single hit.
A risky, yet effective way to, at the very least get rid of Birch's shadows, if not kill him, is to get the Flare Gun and let the Taken corner the player, but make sure Birch is among them. Fire the Flare Gun straight into Birch, or the heart of the crowd of Taken. Most of the smaller Taken will die, and the stronger ones weakened, along with Birch. Birch will probably lose his shadows, giving you an opportunity to get out of the corner the player is in. If any of Birch's shadows remain, burn them with the Flashlight and kill him before the other Taken that may have survived a Flare to the face attack.
Killing Birch is not too difficult. Make sure you keep on moving and sprint away when he gets close, but always keep your flashlight on him, to wear down his strong shield. And make sure that you conserve flashlight batteries, you do not want to be caught dead on power when his shield is up. After you have worn away the shadows from his body with the flashlight, Birch can be killed easily with a revolver, so just gun him down before any more darkness clings to him. Remember though, watch the skies!
- His age is 42.
- In the Alan Wake novel based on the game, Wake witnesses Birch getting attacked by the Dark Presence. In this account, the orderly has not hidden in the closet and is attempting to flee when Alan returns to the scene of the Andersons' escape. He steps into a puddle of liquid darkness released by the Dark Presence and falls to his knees. Wake observes that blood is coming out of Birch's ears, who seems to be suffering from a terrible headache. Before leaving the man to his fate, Wake also notes that the liquid darkness is slowly covering Birch and overwhelming him, turning him into one of the Taken.
- Outside of his nurse duties, he's asked to do shady things for Hartman but doesn't really mind getting his hands a little dirty.
- "You can have the TV on, if you don't fight about the channels."
- "You get two pills in the morning and then you'll be nice and calm all day long."
- "You get three pills in the evening, and you'll sleep like a baby."
- "What are you doing out of bed? Doctor Hartman will be so disappointed."
- "Stop struggling! We're all friends here. This is just part of the therapy."
- "We don't want any fighting. It makes people sad."
- "Doctor Hartman likes things to be nice. That way we don't have any trouble and I don't have to punish anybody."