I found the chapter about the worm in his foot really disturbing and disgusting. I feel like the concept of the worm and the other things that are happening to he, such as his chest pain and Ursula are the things that Lettie feels like she needs to protect him from. The part where the boy let goes of Lettie's hand allows the evil into the boys life and makes it harder for Lettie to protect him.
Its funny that you should mention him holding onto her hand because through out it he's regretting letting go, then at the end he vows that he won't let go, then he let's go to try to she everyone. I have a feeling that holding Lettie's hand might symbolize how he can hold onto hope or trust and when he let's go of that bad things happen
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