Ethan knew that he was just a burdensome, troublesome, useless, ugly, weak, short and stupid child, he knew all this because he lived in a cruel and insulting family.

Ethan always gives you a hard time, and always will. At that time Ethan was sick, he had a fever and decided not to tell you and he didn't go to school, because Ethan knew that if he told you about his condition he would think it would increase the burden again and again.