Patricia Van Tighem

Patricia Anne Van Tighem, nurse and writer: born Calgary, Alberta 22 August 1958; married 1980 Trevor Janz (two sons, two daughters); died Kelowna, British Columbia 14 December 2005.

If Patricia Van Tighem had not prevailed upon her husband to abandon his plans to go rock-climbing and, instead, take her on an overnight trek in the Rockies on the border between Canada and the United States in 1983, then she would simply have continued her life as a tall, blue-eyed nurse. As it was, events took a turn which made her the author of a best-selling, unflinching book, The Bear's Embrace (2000).

Born in 1958, she was brought up as one of 10 children in a Catholic family, then studied nursing at Mount Royal College, Calgary, which she left in the early Eighties and then spent some time on the Ivory Coast. Soon after her return, she met a bearded trainee doctor, Trevor Janz, at a party. As she recalled, "On one of our first dates, we went out Christmas carolling, and hearing him sing them strengthened my determination to hang on to him." They married; life was no less idyllic for the exhaustion and vexation brought on by their both combining medical study with ward duties, she working at Calgary's Foothills Hospital.

As she recalled, the night when they had the argument which led to his agreeing to trek rather than climb, she had looked at her naked, unblemished body in the mirror and thought,

My patients have had breasts removed, tumours investigated, bowels totally resected. I hug myself and shiver.

And so, the trek along the Crypt Lake Trail, reaching 2,000 feet in Waterton Lakes National Park, would be a relief from all that, yet rigorous enough to satisfy "my kayaking, mountain-climbing, glacier-skiing husband and provide a challenge for me, his cautious wife". They set off, at dusk put up their small tent after stringing supplies high between trees, and next day continued on their way, with Trevor ahead of her on the narrow path.

He was singing Berlin's "Blue Skies", and then a grizzly bear charged, set upon him, brought him down. Instinctively, she climbed a tree - something she had never done. But this grizzly, abandoning Trevor, could climb high enough to pull at branches. Twenty feet up, she felt the wood crack beneath her, and she dropped towards a predator who - it later transpired - was guarding a dead sheep, sustenance for her two huge cubs and woe betide anybody else who might have designs upon it. A bear's instinct is to break the jaw of any rival for food:

My mind folds in. A grizzly chewing on my head. Crunch of my bones. Slurps. Heavy animal breathing. Thick animal smell. No pain. So fast. Jaws around my head. Not aggressive. Just chewing, like a dog with a bone.

She was scarcely aware of the bear leaving her, to attack Trevor again, nor of the couple - duly awarded a medal - who helped them back, Trevor holding his jaw together with both hands while running to ensure that the boat on the lake did not leave without them. Morphine duly did its stuff, and, with her head swollen like a football, unable to see anything, she came round in the hospital where she worked. Her husband was in the next room to hers.

Little by little, she was able to open one eye very slightly; she was unaware that skin had been taken from other parts of her and applied to so disfigured a face. She hated to hear that prayers had been said for her, as if these could magic back flesh, and was appalled to think that people could say she was looking well.

All along, she felt no anger towards the bear: that is what bears do, and one surgeon said that the animal had, by design or otherwise, made so skilful a cut to an artery that it immobilised without killing (the animal herself was shot the next day, when going for one of the rangers).

Her left cheekbone was gone, "on the ground somewhere or inside the bear". She and Trevor were able, IV-drips alongside, to take wheelchair rides along a corridor, and chuckle when a nephew said, "You'll have bum skin on your head?" She looked in on a cancer patient whom she had recently been nursing. He said, pragmatically, "I think I hate cancer almost as much as you hate bears."

She had 30 operations. Until bones were taken from her ribcage, there were no bones in her cheek, and she had to live with a patch on a defunct eye. Before long, the eye rotted. It could not be replaced with a glass one, but required a whole rubber unit for the lid and brow.

Small wonder that she was furious when the Calgary Herald reported that she looked better than she had any "right" to do. Among many other problems was dysaesthesia - damage to the nerves which brings many strange sensations - and yet, such was the determination of both husband and wife, perhaps born of medical training, they were back at work and study within in a year. Her eyepatch precluded work in an ophthalmic department - too weird to peer down at patients like that.

Life was not easy. She argued with Trevor, whose beard disguised some of his wounds, and they moved to Victoria, for a fresh start. She gained a BA in nursing, they had a daughter, spent time in New Zealand, returned, had twins, one of whom was born with Down's syndrome, and they all lived in a small house while Trevor himself set about building a bigger one - which of course took far longer than expected.

Depression set in, and she had the first of many ECT sessions, but she was vindicated in her view that an abscess had set in behind the rib to which recourse had been made for bone. She lost a fourth child, but became pregnant again, with a boy. Amidst all this, she worked with a group, AboutFace, for those suffering disfigurement. She knew her stuff. Another second opinion confirmed her view that titanium bolts should be removed from her brow.

Time and again, she pulled through, sufficiently so to write the remarkable book The Bear's Embrace. Told in the present tense, it puts on paper the thoughts that had gone round her mind so many times. It ends with a dream in which the animal, far from attacking her, clutches her closely: mothers can understand each other.

A Canadian best-seller, without need of pictures, it should be published in Britain. As powerful in its way as Jean-Dominique Bauby's The Diving-Bell and the Butterfly (1997), it raises many questions about identity and endurance, the extraordinary amount that the human frame can withstand, and the futility of advice.

Patricia Van Tighem struggled with all this for over two decades, she did wonderfully well, but nothing that anybody could say was enough to prevent her from checking alone into a Calgary hotel 10 days before Christmas. The thought of carols was not enough to keep her from the suicide she had previously attempted.

Christopher Hawtree