NEW YORK - Sadly, wryly, Deborah Mardenfeld describes herself as first in, last out.
First in, because she was among the first to be hospitalized on Sept. 11; she was Jane Doe No. 1 at New York University Downtown Hospital.
Last out, because she appears to be the last of the gravely injured to leave a hospital, something she hopes to do next month.
Mardenfeld, 31, was on her way to work that day when she was hit by falling debris from the second plane that slammed into the World Trade Center. Her legs were crushed below the knees, she lost skin and muscle on her buttocks, she suffered blood loss and trauma that can hardly be imagined.
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She also lost the future she and Gregory St. John had dreamed of; engaged on Valentine's Day of last year, they had planned to be married this year, this month, on Sept. 21. They are still together, but as St. John said recently, "It will be a whole new way of life for both of us - and we were just getting used to the one we had."
Mardenfeld cannot walk without using a walker and spends much of her time in a wheelchair; she needs constant pain medication; she has lost her sense of smell. She has not spent a single night out of the hospital.
On the eve of the anniversary of Sept. 11, Mardenfeld is also dealing with a new sense of loss and loneliness, of being out of sync with other Americans.
"For them, the tragedy is in the past and they are ready to memorialize it," Mardenfeld said from her hospital bed. "For us, we're still in the middle of tragedy."
She worries that she and the others who were gravely injured on Sept. 11 may be overlooked, even forgotten, by the public and the government.
"I don't even know if they ever think about us, much less forget about us," she said. "I don't hear about survivors and the strength that it takes to get through this."
No one knows for sure how many people were seriously injured in the attacks, but survived. The Red Cross says its caseworkers are in touch with the families of 250 such people in New York, Washington and elsewhere.
Because of the confidentiality of medical records, the status of the severely injured remains unclear. But Mardenfeld is believed to be the last one in the hospital.
On Sept. 11 she got up early to go to her job at American Express in the World Financial Center, St. John said. "She woke me up to say goodbye and show me she was wearing her favorite shirt I had gotten her," purple with ties at the neck and ruffles at the wrists.
She never came back.
It is still hard for St. John to talk about the hours he spent waiting, calling, hoping Debbie would be among the thousands he could see streaming uptown.
Mardenfeld had taken the subway downtown to the trade center. When she walked out, she saw the second plane hit the south tower. "I heard, 'Run for cover,'" she said. She did, and that is the last thing she remembers about what she calls "the accident."
She was struck by large pieces of debris, perhaps the landing gear from the plane. Good Samaritans kept her from being trampled and eventually flagged down an ambulance.
When St. John reached her, talking his way through barricades, he recalled, "only her hair was recognizable."
Even so, at first her story seemed to have a happy ending. Doctors were able to save her legs. She appeared on "Dateline NBC" on Sept. 16, able to speak and thanking everyone who had helped her.
But that was not the ending, she says now, "It was the beginning." The next day, she was put back on a breathing tube. She got a series of devastating infections, including one in her spine. The first skin grafts did not take. She was in severe pain, which often did not respond to medication.
Meanwhile, St. John was making a series of hard choices, not only about her medical care, but about their lives. He gave up the third-floor walk-up and found an apartment that was accessible to wheelchairs - and twice as expensive as their old place.
In part to pay for it, he gave up hope of staying in academia (he got a doctorate in May 2001) and took a research job in New Jersey.
And there have been unhappy discoveries, like the fact that Mardenfeld and the other injured people were not eligible for some kinds of government assistance. "She's just not a victim to them," he said. "How do I even respond to that?"
Though she left intensive care in February and was moved to a rehabilitation center, she could not even stand up until June.
Since then, however, her body - and spirit - have strengthened. She has created a garden on the windowsill of her room. Monday, she took her first steps using a cane.
If she could change something about that day, Mardenfeld said, it would be that the injured "should be recognized, we should be cheered."
"There shouldn't be a moment of silence for us," she continued. "We all lost so much that day, but we're still here. And that in itself is a miracle."