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Ruthie is the aging yet seductive snake charmer with the carnival. Her son, Gabriel, is the carnival's strong man. Ruthie has been with Carnivàle for quite a while, and was with them during Scudder's tenure with the outfit. The snake charmer and the gentleman geek formed an intimate relationship, though Ruthie acknowledges that Scudder never forgot Flora, the woman he left behind in Oklahoma.
It is Ruthie who seemingly manages to persuade Samson to shelter Ben from the law in Milfay, and it's Ruthie who appears genuinely concerned for the boy. Ben, for his part, is no less attracted to Ruthie, but must grapple with the feelings that his mother condemned at every opportunity. The two begin an awkward and strained courtship, which Ben almost ruins when he finds out that Ruthie slept with Scudder. He apologizes for his outburst and, when Ben is on the brink of madness, tormented by horrific dreams every time he closes his eyes, the two consummate their affection. But since this is Carnivàle, nothing works out like it should, and before long Ruthie has been killed by Lodz, acting under Management's orders. The deed is part of a grander scheme on Management's part to provoke Ben into using his powers to their full extent and accepting his heritage. In the end, it works and Ben kills Lodz and resurrects Ruthie.
Things between the young healer and the older snake charmer do not return to normal, unfortunately. When Ben emerges from Management's trailer, he is distraught and overwhelmed. He also sees now how those that he cares about can be used to manipulate him. As a result, he expresses his happiness that Ruthie is "well" again (since she doesn't know that she died), but also makes it clear that he no longer wishes to be with her.
The older woman is crushed and confused, since she believes that Ben merely sat with her until the snake venom left her body. However, Ruthie is soon troubled by more pressing matters. Due to her recent resurrection, she now has an uncanny connection to the spirit world. She begins seeing long-dead friends and lovers, as well as Apollonia and Lodz. She tells Sofie about seeing Apollonia, but Sofie is still traumatized by almost being murdered by her mother to respond.
Eventually, Ruthie finds herself sleepwalking and performing extremely odd actions, like writing "Sofie is the Omega" in lipstick on her mirror. As it turns out, Ruthie is being temporarily possessed by Lodz so that he can make use of a physical body (presumably so that he can subject the audience to more disturbing sex with Lila). Regardless, nothing comes of Lodz's machinations, and when Ben reveals his true nature to the rest of the carnies, Ruthie forgives him.