The Ramirez women of Staten Island orbit around absence. When thirteen‑year‑old middle child Ruthy disappeared after track practice without a trace, it left the family scarred and scrambling. One night, twelve years later, oldest sister Jessica spots a woman on her TV screen in Catfight, a raunchy reality show. She rushes to tell her younger sister, Nina: This woman's hair is dyed red, and she calls herself Ruby, but the beauty mark under her left eye is instantly recognizable. Could it be Ruthy, after all this time?

The years since Ruthy's disappearance haven't been easy on the Ramirez family. It’s 2008, and their mother, Dolores, still struggles with the loss, Jessica juggles a newborn baby with her hospital job, and Nina, after four successful years at college, has returned home to medical school rejections and is forced to work in the mall folding tiny bedazzled thongs at the lingerie store.

After seeing maybe‑Ruthy on their screen, Jessica and Nina hatch a plan to drive to where the show is filmed in search of their long‑lost sister. When Dolores catches wind of their scheme, she insists on joining, along with her pot-stirring holy roller best friend, Irene. What follows is a family road trip and reckoning that will force the Ramirez women to finally face the past and look toward a future—with or without Ruthy in it.

What Happened to Ruthy Ramirez is a vivid family portrait, in all its shattered reality, exploring the familial bonds between women and cycles of generational violence, colonialism, race, and silence, replete with snark, resentment, tenderness, and, of course, love.