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Ruth was clever, hardworking and focused as a medical student. She always performed well academically and didn't seem to know the meaning of failure, something which earned her admiration - if not necessarily friendship- from her fellow students. Not that she cared - Ruth's professional ambition had always come at the expense of her social and personal life. Being a doctor was Ruth's ambition from the age of eight and it seemed to be all that mattered to her.

However, once Ruth was in the ED dealing with real patients and real colleagues, she struggled to cope. After seriously misdiagnosing several patients and failing to bond with the team, she attempted suicide. Found by Abs and Toby, she eventually recovered and returned to work. But when new clinical lead Nick Jordan rejected her after they had a one night stand, her confidence took a further knock and she decided she wanted to get a surgical rotation and get away from the ED.

She paid Jay to accompany her to several surgical events but the pair grew closer and began dating for real. However, when Ruth realized she was pregnant she felt unable to cope and secretly took the abortion pill. She reacted badly to it and collapsed. Jay assumed that she had suffered a miscarriage and, unable to deal with her own deceit, Ruth dumped him. They did get back together, but when Ruth confessed to the abortion Jay left her. It was at this point that she was offered another chance at a surgical post but she turned it down to help Jay, who was the victim of an unethical surgical trial.

Determined to become a surgeon, Ruth married influential surgeon Edward Thurlow, but she was devastated when Edward didn't give her the surgical promotion she desired, and was even more distressed to discover that he was gay. Eventually Edward left her for a man and Ruth threw herself into work, but the mounting emotional strain caused her to suffer a breakdown in the ED and she was sectioned after attempting to operate on a patient in the on call room.

Ruth was diagnosed with bi-polar and eventually returned to work part time. She forgave Jordan for having her sectioned, helped Charlie to care for his granddaughter, and got back with Jay. Ruth fell pregnant again and struggled to cope with the idea, especially since the pregnancy meant she would have to stop taking the medication for her bi-polar. She attempted to reject Jay but when the pair found themselves trapped in the ED fire she realized what was important in her life - both she and Jay quit the hospital and were last seen leaving Holby in a camper van.

• Ruth's family background was troubled. Her mother committed suicide when she was young, her father was an alcoholic and her brother was a drug addict who got sent to prison. Both Ruth's father and her brother, Jonathan, turned up in the ED.
• Jay pledged his undying love to Ruth at the register office - just after she had got married to Edward!
• When Charlie discovered the truth about Edward's homosexuality she schemed to have Charlie transferred to a post on the psychiatric ward. However, he forgave her and supported her through her breakdown.
• After initially disliking each other, Ruth developed a good 'brother/sister' relationship with colleague Toby de Silva.