"Sex and Death" is the 615th episode of Casualty and the 25th episode of the 22nd series. Despite being in a coma for the events of the episode, Ruth Winters appeared in alternate timeline sequences as Harry reflected back on her life whilst reading her diary.
Following Ruth's suicide attempt, Harry reads through her diary as the events of the past few months are revealed through the use of flashbacks. It begins with her arrival to the hospital and then about her family. It then shows that Adam set Ruth up to shadow the histology department much to Ruth's annoyance but she decided to stay there. Ruth's histology friend, Dominic, manages to secure her a slot in assisting Sarah Evans in surgery on Boxing Day. She then feels led on by Dominic which in turn adds to her depression when he turns her away. Ruth's suicide letter states that her life is summed up by 3 pieces of paper: a birthday card from a father that never loved her, a Christmas card from a man she thought did and a visiting order from her brother. After the incident the team go to the pub to drown their sorrows where Maggie feels bad after Ruth previously asked her for guidance to which she refused to help. Adam and Zoe share a kiss outside the pub where they decide that they are not compatible and to forgot about the incident. Adam then continues to flirt with Jessica and offers to walk her home. Harry tells Tess that the department has let Ruth down by not being there for her.