Early on, it is learned that Kathy, the narrator, is a 'carer'. All that is known is she cares for patients and all of the patients seem to be in a good mood, even after multiple donations.
Tommy's personality is shown when we find out he throws fits when people taunt him. He does not control himself and lets others egg him on.
Ruth's personality starts to really to show through during this interaction. Ruth claims that she got her new pencil pouch from Madame because she was her favorite, but Kathy doesn't but it and challenges where she got it from.
After one of Tommy's fits where he ended up hitting Kathy, they sit down and talk about what happened. During this, Tommy admits that Madame told him he did not have to be creative if he doesn't want to. Kathy is really surprised by this.
Madame is caught crying when she walks in on Kathy singing to her favorite cassette tape and pretending to be holding and singing to a baby.
Miss Lucy is talking to the kids about their future of donating vital organs. Miss Lucy gives them information bit by bit, so this is a huge piece to the puzzle.