Patient Harm from Medical Misadventure

"A 1999 Institute of Medicine (IOM) report, found up to 98,000 people were dying in US hospitals each year from preventable medical errors."
"In 2016, a review from Johns Hopkins hit on an unimaginably high number. Looking at studies published since the IOM report, many of which were based only on insurance claims, these researchers concluded that 251,454 hospitalized patients died from medical errors each year."
"A recent and more rigorous study came up with a far more conservative number than either the IOM study or the Hopkins research."
"Rather than simply looking at 'medical errors', authors of this study examined all adverse events and their link to patient mortality, whether a mistake or not."
"Using data from the Global Burden of Diseases, Injuries, and Risk Factors (GBD) between 1990 and 2016, instead of simply using insurance claims, the new study settles on a number 50 to nearly 80-fold smaller than the Hopkins review."
"Across the entire study period, the authors found 123,603 deaths in which adverse events were determined to be the underlying cause of death. And after controlling for population growth and ageing over those 26 years, they found that those rates had actually fallen by over 20 percent."
"Of all the deaths related to adverse events, the study found 8.5 percent could be attributed to misadventure, or medical errors such as accidental laceration or incorrect dosage, and 14 percent could be attributed to adverse events associated with medical management."
"This isn't to say that mistakes made by medical professionals are not a problem, or that they shouldn't be fixed. Merely that grossly exaggerating this number to the point of a crisis, where a huge number of people who are hospitalized could die from a medical mistake, is demonstrably false and dangerous."
Science Alert

"Canadians place great trust in health-care organizations and are generally satisfied with the health care they receive. In 2005, 85 per cent of Canadians who received health care were 'very' or 'somewhat satisfied' with the services they received.^" "Additionally, in a recent Canadian Institute for Health Information survey of patients accessing primary care, more than three-quarters (76 per cent) reported that the quality of the primary health care they received in the past 12 months was either 'excellent' or 'very good'."
"However, a growing body of evidence over the past decade has demonstrated that misadventures during surgical and other medical care are common around the world, and Canada is no exception." "These misadventures are tragic for individuals and costly for society, as they can result in disability, death, or prolonged hospital stays. A Canadian study estimated that about 7 per cent of adults seeking acute care in Canada experience a misadventure; from these cases, close to 60,000 are potentially preventable. The latest OECD figures show that about 150 deaths are caused by misadventures during medical care each year in Canada."
The Conference Board of Canada 

Auditor General Bonnie Lysyk released her annual report for 2019 on Wednesday, and called for immediate action to reduce the number of patients who are injured while receiving care in Ontario's hospitals each year. (Paul Chiasson/Canadian Press)

"Each year, Ontario hospitals discharge one million people. Of those, about 67,000 people were harmed during their hospital stay."
"Many [long-term care home residents] require assistance eating and drinking and rely on long-term-care home staff help to maintain their health."
"Ontario has committed to spend $3.8 billion over ten years to 2026-2027 for mental  health and addictions services, so it's important that funding is allocated appropriately to meet the needs of Ontarians."
Ontario Auditor General Bonnie Lysyk, 2019 annual report

The audit found that hospitals are currently not required to report so-called "never-events" - a medical error that should never happen, such as leaving a foreign object inside a patient - to the Ministry of Health. File/Global News

Close to 70,000 patients receive injuries while in the process of receiving care in hospitals annually in Ontario, according to the province's auditor general who called for government action to help in reducing that number. The auditor general's team audit of acute-care centres resulted in the finding that six of every one hundred patients treated then discharged from hospitals in the province received harm during the process of health care provided to them.

Hospitals have no legal requirement to report to the Ministry of Health any medical error that should never happen, called "never-events". In that category would be leaving a foreign object inside a patient after surgery. The audit team visited six of thirteen hospitals that do track "never-events", finding that 214 incidents had occurred since 2015. Hospitals failed to comply with required safety practice standards on occasion, and what's more nurses repeatedly fired for reasons of incompetence often were re-hired by other hospitals.

Credit Ontario Ministry of Health and Long-Term Care

The audit recommended that hospitals and nursing agencies should be alert to and prepared to share information such as this with one another regarding poorly-performing nurses. Disciplining doctors was found to take years and in the process deleteriously impacted a hospital's budget; potentially making hospital administrations loathe to undertake needed disciplinary action. In one instance it cost a hospital $560,000, taking several years to finalize the discipline of a doctor with "practice issues".

Two other hospitals involved in disciplinary action against the very same physician laid out $1 million for their efforts to discipline the man. As legal costs for physicians in discipline matters are paid by taxpayers since government reimburses doctors for malpractice insurance fees, the auditor general felt the outcome is that doctors are willing to draw out disciplinary cases for years since there is little personal cost to themselves.

Food and nutrition in long-term care homes was another issue the auditors found is lacking to meet quality standards, when food is given patients that includes an excess of sugar and salt, and lacking sufficient fibre content. In three of five homes inspected by the audit team, patients were served food past their best-before date. Liquid whole eggs that were three months past best-before dating, was served in one of the homes, as an example.

iStock.com/Chinnapong

And as for addiction services, the audit team found wait times for treatment, opioid-related emergency department visits and death rates all rising, regardless of increased government funding. Adequate policies and procedures are lacking, to deliver timely addiction services, to monitor service providers, or to measure and report on effectiveness, according to the report's findings.

Another point of contention is that $40 million of the province's $134 million opioid strategy is equally distributed throughout all Ontario regions, and not preferentially based on need.

Searching Out Awesome Thrills

"I looked down once and I thought to myself, 'This is it, I'm going to fall to my death. I'm a goner."
"I just locked on and held on as hard as I could. I didn't have much grip left in me at all. My hand was opening, I was slipping."
"Gail [his wife] and her pilot took off first…. looked cool as hell. Then my pilot and I lined up for takeoff. We waited a bit for the updraft to pick up and then we ran till we left the side of the 4000 ft mountain edge. I was expecting to level out above the pilot as we went, but quickly discovered that my harness was not attached to the hang glider or anything else…"
"While the pilot made a critical error in our pre-flight set-up by not attaching me to the glider, he did all he could to get me down to the ground as quickly as possible while grabbing onto my harness and flying with one hand."
"My body weight shifted straight down and I found myself hanging on for my life. I remember looking down and thinking, this is it. I was losing grip with my right hand that was holding onto a strap on the pilot’s right shoulder. He was trying to make a beeline to the landing field as he knew what the situation could bring."
"As we were going down for a hot landing I was slowly losing my grip with my right hand as I was swinging in the wind with the glider. The pilot grabbed my hand, but like in the movies it was a slow motion slipping of the grip until my right hand slipped off and I grabbed another strap on his left side for a bit but this slipped off also."
"I ended up holding on the bar with the left hand and the lower part of his leg with the right when we were nearing the ground."  
Chris Gursky, American tourist in Switzerland

Chris Gursky and his wife, Gail, were on vacation in Switzerland when they decided to try hang gliding for the first time.

Working as an auto-parts store manager and photographer might not be the most fascinating job in the world, so it's possible that Chris Gursky of North Port, Florida was ready for some drama and life-changing excitement. He might not have imagined just how life-threatening that drama might turn out to be, but then who among us does when we set out to do something out of the ordinary to break up the tedium in life's routines?

This would be Mr. Gursky and his wife Gail's first such adventure; hang-gliding, but it seems they needed no convincing that this first-time exposure to the thrills of the recreational 'sport' would add something to their lives. In fact, it came close to subtracting something vital to both their lives. He might have ended up very dead, and she a widow. Not the kind of thought that appeals to most people looking to be entertained.

No one, least of all, Mr. Gursky, and perhaps the pilot who somehow overlooked the most vital safety assurance incumbent upon an instructor-pilot having someone else's life in his hands, might foresee. But accidents happen and one man's forgetfulness can translate as another man's ill fortune. In this instance, however, it was not to be and Mr. Gursky had the good fortune to come away from his rather unorthodox experience in hang-gliding relatively unscathed.

No serious physical injuries incurred, though it's remotely possible he will have nightmares for a while. Remotely in the sense that because he had been unable to experience the thrill of a safe hang-gliding exploit, he is still determined to do so and plans in the future to give it another try. This time, however -- if there is another 'this time' -- he will know enough to ensure that he is securely strapped on to the device even if the professional momentarily and almost-catastrophically forgets.

The episode took two minutes total, start to finish. It started badly and ended extremely well. Both Mr. Gursky and the pilot shaken needless to say, but both survived what appeared at first to be the epitaph of one man in failure to launch and the haunted conscience and loss of professional gravitas of the other. Generously, Mr. Gursky praises the pilot as a "good guy" who "did all he could and more" ... aside from neglecting to secure him as per standard avoidance of death technique.

Still from video   Global News

They took off from a 4,000-foot mountain ledge (be still, my heart) when the realization hit that there was nothing securing him to the glider, the harness he was fitted with was nicely in place but unattached. Mr. Gursky found himself dangling to the left of the pilot, clinging to the bar of the glider and alternately to the pilot, not too enthused about meeting the ground prematurely with nothing to cushion the impact.

He did deliberately loose his grip on the pilot/glider at just the right time, ejecting while moving at 70 km/h, seconds before the glider landed in a field of grass. A broken wrist and a torn biceps tendon was what the effort cost him. On the other hand, the video documenting the entire episode has found a celebrated home on YouTube with over a million gawping views by Tuesday following the Monday event.

And Mr. Gursky is now a celebrity of sorts. To whom congratulations for his survival of an untoward incident is due.

Still from video   Global News

Breathe Deep, Don't Panic. It Won't Help....

"I don't think we're heading toward a crisis, I believe we're already there. If we look at the reliability of a large number of pieces of equipment, it's really the worst it's ever been."
"We're into almost this downward spiral. Service technicians are getting loaded up with more and more, having less time to do preventive maintenance."
"The less preventative maintenance you do, the more problems you're going to have."
Rob Isabelle, mechanical engineer, elevator consultant

"It [the elevator she was in] started making a lot of banging noises. Then the lights went out. There was a lot more banging went on, and then it dropped to the basement."
"It jolted me when we came to a stop at the bottom. I didn't know what was happening or when it was going to stop. Everything was black. I kept trying to press buttons to try to make it open the doors but nothing would happen."
Nancy Lean, 46, Toronto

Elevator Crash at Philadelphia Criminal Justice Center, August 4, 2016, Critically Injuring Sheriff's Officer Who Was Thrown Like 'Projectile' NBC 10

This woman found herself trapped in an elevator at York Regional Police headquarters in Aurora. This was her workplace. She was on her way to the second floor when the elevator suddenly turned rogue and unamenable to responding to the instructions given it through the up-to-then reliable button system which simply failed to respond. This was, without doubt, an experience that anyone finding themselves in wouldn't be too anxious to repeat.

But it's an experience that is being repeated and repeated and repeated. Infrastructure, particularly mechanical-electrical types grow old and cranky; there is fatigue of the system and its various parts and eventually something will go wrong. Building owners know all this, that it is the cost of doing business to have insurable, reliable equipment in their buildings. To that end they contract for regular maintenance from the industry that services elevators.

Often enough these are the very same corporations that build them, huge multinationals like Otis, Schindler, Kone and ThyssenKrupp. There are also small, independents who also offer similar services. Understandably, they may have the expertise to compete, but the big corporate interests don't look too kindly at their presenting as alternative service ports. So it all comes down to marketing and undercutting competition by low-balling contract pricing.

The fact that there are so many elevators everywhere means that there's a lot of business to be had. It was profitable business at one time. But in the competition to grab greater portions of the market share, even as the elevators themselves were steadily aging and requiring more attention they began receiving less servicing and break-downs began to proliferate.

Imagine living or working on a floor above, say, the tenth floor of any building and the elevator/s break down. That's no mere inconvenience, that's a huge disruption and difficulty; not everyone is in the athletic shape it takes to trudge up and down stairs. According to Mr. Isabelle,  thirty years earlier the typical workload for a technician would be to service roughly 35 to 45 elevators for which the cost would be $1,000 per elevator per month.

Such maintenance contracts would be all-encompassing, inclusive of due diligence, repairs as needed, adjustments as required, and the elevators would be reliable in their workhorse capacity with no surprises. At the present time, that very same contract's price has been reduced to about $600 to remain competitive in the undercut-marketplace of opportunity and increased market share. Moreover technicians -- at that price -- are responsible now for 100 elevators.

The four large multinationals named above had their European operations fined over $1-billion in 2007 for having colluded on pricing, which exacerbated the prevailing, reasonable system of contract-and-service, to cut out the small independents which were taking business away from them, while doing a creditable job. The small independents just couldn't compete with the cut-rate pricing of the multinationals and went out of business.

Elevator Crash at Philadelphia Criminal Justice Center, Critically Injuring Sheriff's Officer Who Was Thrown Like 'Projectile' NBC 10

This has resulted in property owners and managers of older buildings in particular facing a dilemma. Parts and technicians capable of handling aging equipment have become few and far between. The option of replacing elevators with more modern ones can run to between $150,000 to $300,000 for each replacement, only partially recoverable from tenants over a prolonged period.

The crisis of elevator break-downs is on the rise. How common are those break-downs where people find themselves trapped on malfunctioning elevators, and in some instances are injured? In the province of Ontario alone last year firefighters responded to 4,461 emergency calls to extricate hapless people from elevators; a dozen a day, about double such occurrences in 2001.

Toronto had about 2,862 elevator-rescue calls to 911 last year. Montreal firefighters responded to 1,532 calls, and Vancouver responded to 428 calls, and in the nation's capital, Ottawa, 314 calls went out to come to the rescue of trapped elevator victims.

On Saturday, the Colorado Springs Fire Department confirmed that the reason Trump’s event started late was because he got stuck in a hotel elevator and had to be rescued by Colorado Springs firefighters.
The fire department said in a statement that Trump was trapped inside an elevator at The Mining Exchange Hotel with about 10 other people. Fire officials said Monday those inside were trapped for no more than 15 minutes.
Firefighters opened the top elevator hatch and lowered a ladder to get everyone out of the elevator.  The Denver Post

Pit-Bull Ownership

"We hopped the fence and found her in the balcony being severely mauled by this pit bull. She had significant blood loss and flesh loss as well. It was doing a number on her."
"He [the dog] paused long enough for us to get [the woman] out of the doorway and let the door shut [after repeatedly bashing it with a stout piece of wood]."
"In the time I went from [getting on] the balcony to hitting the dog, he’d bit chunks of her three or four times right in front of me, while I was hitting."
"I’d like to see (Rideau-Vanier ward Coun.) Mathieu Fleury and bylaw [services] do something. There’s a lot of pit-bulls in Vanier and there aren’t enough people who are educated about how they can be."
Michael Holmes, neighbour

"I tried to grab anything clean I could put on the wounds because they were horrific gashes [Lindsay, professional first-aid instructor]. You could see down to the fatty tissue and the tendons on her arm."
"When the paramedics came they put tourniquets on her arm and leg so she was bleeding quite a bit."
Lindsey Holmes, neighbour

Lindsay Holmes and Michael Holmes stand in their backyard. Behind them is the fence they jumped to save their neighbour being mauled by a pit bull.

"[It was a] freak accident. I train pit bulls. I train Rottweillers. All dogs that have teeth bite! If the owners are stupid, they have stupid dogs."
"It's like a two-year-old kid. If you train them properly not to be an assh---, then they won't be."
Garfield, Vanier neighbour

 The unidentified woman fortunate enough to have had neighbours come to her rescue while she was being mauled, lives in the house behind that of Lindsay and Michael Holmes, on the street backing on their own, in the Vanier area of Ottawa. Michael Holmes, interviewed in the aftermath of the incident where he and his wife saved the life of a stranger, spoke of his frustration at the presence of pit-bull type dogs in his community, plenty of them, despite that they're outlawed in Ontario.

The woman who had been mauled lives upstairs in the house she shares with her daughter, who lives in the downstairs portion of the house. Both mother and daughter each owned their own pit-bull-type dogs. The mother had gone downstairs in her daughter's absence to feed her dog, when it turned on her and began viciously mauling her. Fortunately for her the Holmes couple heard her frantic calls for help and they responded with alacrity.

Afterward, the daughter's husband said there was no history of aggression with the dog, they're unable to account for the attack, since his mother-in-law was familiar with the dog and often looked after it in their absence. "We're just devastated", he said, both presumably that his mother-in-law might have lost her life, and the very pertinent fact that his dog is now scheduled to lose its, even while the Ottawa Humane Society has been its temporary custodian, post-attack.

The ban on pit-bulls was brought into law in 2005. Any existing pit-bulls were exempt, but the dogs had to be sterilized and muzzled in public, as well as being kept on leash. That same law prohibits the ownership and presence of pit-bull terriers, Staffordshire bull terriers, American Staffordshire terriers, American pit-bull terriers; in fact any dog which "has an appearance and physical characteristics substantially similar to any of those dogs".





Obviously, there has been little-to-no enforcment of the general ban, something the neighbours of the 50-year-old woman whose arm doctors were uncertain they would be able to save from amputation, were quite exercised about. The dogs owned by this very woman and her daughter were no more than three or four years old, their ownership in direct defiance of the law. "They're everywhere in Vanier. I almost lost my eye", said Guy Cloutier, of an episode where a neighbour's pit-bull attacked him.

"He [the pit-bull owner] didn't want to give me the money [he owed], so he sent his dog after me instead", he said, adding that the man was placed in jail and his dog taken into custody. "Lots of young men have them", said his friend Diane Monette with whom he had been strolling down the street when they were interviewed. "Crack dealers have them. It's really too bad." Another neighbour, Pierre, spoke of his own "weird guy" of a neighbour who allows his pit-bill to wander about without a leash or muzzle.



And then there was the man who divulged his first name only as Garfield, who said he has pit-bulls himself. And as he and the interviewer approached a nearby house the door opened and as it did two heavily-muscled dogs bearing the tell-tale square heads bounded out onto the street. At which point, Garfield, who was so effusive about the unnecessary fear of pit-bulls screamed out "Don't look at the dogs! Look at me!"



A month earlier, a 55-year-old woman was attacked by a pit-bull in her own backyard. Her funeral followed shortly afterward. Her neighbour's dog had gone into hers through a hole in their shared fence. "There's a need, and a want, to take some action on this, from all the neighbours I spoke to", said Michael Holmes. "Nobody wants this to happen a second time. Who's next? A child?"
 

Christiane Vadnais, left, died June 9 after she was attacked by what police described as a pit bull. (Facebook)

Lucky Neophytes

"We flew them up to a beautiful spot so that they could say their last goodbyes."
"We were looking right down and over the U.S. border, and anytime there was a wisp of smoke, we descended on it rapidly."
"They were disoriented ... lost, they didn't know which direction to go."
Paul Berry, Comox (B.C.) Search & Rescue

"We've had people break legs and we've found them the next day, but we've never really had anybody go missing like this."
"I honestly don't know what they did."
Cathedral Lakes Lodge employee

"[There is] no sign of these people whatsoever, no signs left for us, no material tied to a tree. ... It is just kind of like they vanished."
Cpl. Dave Tyreman, Royal Canadian Mounted Police

"For them to actually go down and move into the trees would have been really strange to do, so we spent most of our efforts searching the alpine areas."
Alan Hobler, search coordinator

Lynne Carmody, from North Bay, is shown in this handout image. Search-and-rescue crews were shocked when an Ontario couple missing for seven days walked out of the backcountry in southern British Columbia. Carmody, 61, and Rick Moynan, 59, of North Bay, Ont., turned up virtually unharmed on Sunday around 4 p.m., just hours before crews were going to call off the search for them. THE CANADIAN PRESS/HO

Two people from North Bay, Ontario were vacationing in British Columbia, staying over at a popular place that usually hosts serious hikers, the Cathedral Lakes Lodge. Lynne Carmody, 61, and Rick Monan, 59, informed people at the Lodge they planned to do a hike over to Glacier Lake, a two-kilometre distance which should take only 30 minutes each way.

When dinnertime arrived and they hadn't returned the lodge dispatched a search party to scan nearby trails, but they weren't successful in finding the pair. The lodge then took the step to alert the Royal Canadian Mounted Police. Three days passed with the RCMP looking for the missing hikers, and there were other rescue groups attempting to discover what had become of the pair as well.

They were novices at hiking, but outdoor life was not completely unknown to both of them. Lynne Carmody's deceased husband had himself worked in search and rescue and Rick Monan, according to family and friends, had some outdoors experience of his own. But people can and do become lost and this couple certainly did when they took a detour then found themselves far from their starting point.

Rescuers assumed that the two, if indeed lost, would gravitate to places where they could be spotted overhead by search and rescue aircraft. But they had decided evidently to remain in the woods. There they built a temporary shelter and remained in close distance to a stream for water. Should they have moved to high ground where treeless alpine tundra dominates, they might have been able to get their bearings.

They had embarked with no gear at all. No food, no appropriate clothing or survival gear, having to cope with temperatures soaring to 40-degrees Celsius. They decided to find shelter in densely wooded areas, where none of the three helicopters buzzing about could possibly detect their presence. It cannot have been too pleasant, since nasty devil's club is part of the understory, and biting insects have a field day with warm flesh.

Finally, rescuers assumed they had met with misfortune, perhaps fallen off a cliff and in the remote wilderness area it would be unlikely their bodies would be found anytime soon. The search had gone on for seven days, and hope they might have survived whatever their ordeal had been had waned; they were presumed dead.

Then just as the last of the search teams proceeded to wrap up their fruitless search where they had gathered with family members of the two missing hikers to enable them to have a last look at the final resting place of the two absent hikers, it just happened that two figures emerged from the woods to approach an idling rescue helicopter.

They were in fine shape; perhaps a little dishevelled, exhausted, hungry and thirsty, insect-bitten, but basically fine. They even decided to return to the lodge before being taken to hospital for a check-up, so they could enjoy dinner, to the amazement of other guests.

Living Within Nature's Wild Precincts

"Claudia and I didn't want to play the game anymore. We wanted to do something different."
"We didn't have a clue what to do here [Yukon]. But it was our future. We just knew we had to be here."
"This is not a place for a city person. But we learned how to do everything."
"Claudia was unconscious. It took me 20 minutes to get to the medical centre. The nurse was there. We needed to do CPR. I held Claudia's feet as we brought her inside."
"I was able to see her afterwards. Her face was serene, beautiful. I took her hand in mine. I smelled her We lit a candle in the nursing station, because Claudia loved candles. We always had 20 or 30 candles burning in the house. I lit a candle. I said goodbye to my love."
Matthias Liniger, Four Mile Creek, Yukon

Claudia Huber, her Malamut companion Kona, Yukon

"Being in poor condition, and still out at this time of year, this particular bear was looking for food. It was looking for a moose, a caribou, a road-kill."
"This was a chance encounter."
Ryan Hennings, Environment Yukon conservation officer

We were ourselves concerned about the potential of chance encounters when we set out twenty years ago with our youngest son, a biologist, to do the circuit of Bowron Lakes, set in the Cariboo mountains of British Columbia. We asked the provisioner from whom we rented the canoe and paddles we used, whether it might be wise to buy pepper spray. He looked sideways at our fit and muscular son, shrugged, and said in an aside to him, that he could easily outrun his mother. Ha-ha.

When we were paddling daily from lakes to rivers on the circuit, settling down in the late afternoon to set up camp, pitch our tent and prepare dinner, we were busy, and didn't give too much thought to coming across a grizzly, though they were there, somewhere, just not where we happened to be. Idly, we would occasionally focus binoculars at mountain slopes opposite our camp. At night a tall ladder had to be lifted to nearby trees where a platform rested high in the forest canopy, and where our food backpack had to be left overnight; standard camping procedure anywhere in the wilderness.

At one juncture in our week-long circuit we happened to come across a different type of food security arrangement, one that we understood was no longer in use. This was a food safe, a large rectangular steel safe presumably used at some camp sites in the past. It had seen better times. Clearly, a grizzly or a succession of grizzlies, had attempted to open it, their keen sense of smell informing them at any given time while in use, that it held edibles. That steel strongbox was dented, askew, worn and depleted; a complete and utter wreck.

Another time we paddled toward a pebble beach where we took the opportunity to stretch our legs a bit after hours of paddling. In the rain. Always in the rain. The week we were there the rain was interminable, never-stopping but for brief intervals. And since we were at about the 3,000-ft.level, it was cold; we wore winter jackets under rainsuits. We were still able to set up our tent and prepare our campsite, somehow, and deconstruct it all the following morning before once again setting out for our day's adventure. On that beach we saw the distinct prints of caribou and wolves.

Nature in all its wonder and fury holds an irresistible attraction for many people. The geology; paddling on a liquid-blue lake, the wind blowing, surrounded by the peaks of mountains marching off into the distance, the green of conifers to the treeline, then a cone of snow. As it rained during the day, you could look up, above and see the snow spreading on the mountain summit. It is breathtaking, beyond beautiful. At night, hearing a screech owl is an experience unlike any other. During the day, seeing birds in flight, and sometimes a large salmon swimming the river you're paddling on, another experience.

Claudia Huber and Matthias Liniger meant to change their lifestyles completely, not just fly across a vast country as we had done, to experience raw nature. They dreamed of leaving Switzerland and the work they did there, for another kind of lifestyle opportunity. As a child he had dreamed of the natural world and the animals that inhabit it. He had been to the Yukon years earlier. Years later the Swiss-German couple travelled to Canada then drove about in a rented recreational vehicle.

Matthias Huber   The Yukon property of Claudia Huber and Matthias Liniger. Claudia was killed by a bear.

They looked at a property, a rural property on Four Mile Creek in 2006, outside the village of Teslin in the Yukon and having liquidated their Swiss property, they bought the one they looked at and were to name their own. They became Canadian citizens and looked for work nearby. They learned their way around. Claudia herself was able to work a trap line, shoot a rifle, use a chainsaw. They planned to turn their property into a retreat for the adventure-bound tourist who might want to stay with them in one of the two cabins they were to build for guests.

They were aware of being vulnerable to a degree, and were careful to take bear spray when they were out and about. They had a large Alaskan malamute as a companion and early-alert warning system. On October 18 of this year Kona the malamute began barking furiously at eleven in the morning. That led Matthias to venture outside to see what had upset Kona. He had left his rifle inside. In the ensuing succession of events, the grizzly entered the house smashing through a window, leading Claudia and Matthias to exit it.

By then Matthias had his rifle. But by the time he managed to shoot the grizzly it had chased down and already mortally mauled Claudia. He hurriedly drove his wife into town for medical help. She did not survive, though heroic measures were desperately taken to try to save her life. A funeral took place in Whitehorse for Claudia on Wednesday. Her husband plans to remain, with their faithful dog, at the remote cabin site on Four Mile Lake To forge on with their plans to transform the property into a tourism destination.

"Coming to the Yukon was our dream. We were so proud when we got our Canadian citizenship. I hope I can stay on at Four Mile, just to feel Claudia's spirit around me. She is everywhere, in that place. I have to find a way to hold onto that", he said, speaking with Joe O'Connor, a journalist with the National Post.

Nepal blizzards claim lives of at least 12 trekkers

BBC News online -- 15 October 2014

At least 12 people have been killed and many more are missing in blizzards in the Himalayas in Nepal, officials say.

Trekkers were trapped in heavy snowfall as they returned from the Thorung La mountain pass on the Annapurna Circuit, in Mustang district.

Nepalese, Polish and Israeli citizens are reported to be among the dead. Nearly 40 others were rescued.

Meanwhile five more climbers are presumed dead after an avalanche in nearby Manang district.
Officials say four were from Canada and one from India.

Three Nepalese farmers have also been killed in a separate avalanche in the same area.

Analysis: Phanindra Dahal, BBC Nepali, Kathmandu

2014 has not been good a year for Nepal's trekking and mountaineering industry. An avalanche on Mount Everest in April killed 16 Sherpas - and resulted in a near complete halt to expeditions to the world's highest peak during the spring season.

The latest disaster comes during the peak trekking period. Thousands of tourists head to Nepal in October, many to enjoy its high altitude mountain passes and pristine beauty. The freak heavy snowfall caught the trekkers off guard.

The tragedy will badly hurt Nepal's tourism, with officials worried about the wider negative message it sends. Trekking and mountaineering are the key backbones of the industry - the major foreign exchange earner for Nepal.

Officials have said that the unexpected snowfall was probably caused by the tail end of Cyclone Hudhud, reports the BBC's Phanindra Dahal in Kathmandu.

Hudhud hit south-east India earlier this week - satellite pictures now show it moving away from Nepal towards China.

The bad weather hit a resting place 4,500m (14,800ft) above sea level, not far below the Circuit's highest point, the Thorung La pass.

The trekkers who were killed or remain missing were on their way down.

An army official co-ordinating the search operation said two military helicopters had been sent from the capital Kathmandu to assist the rescue operation.

Correspondents say the latest disasters are another massive blow to Nepal's trekking industry which plays a vital role in the country's economy.

Thousands of trekkers visit the Annapurna region every October, when weather conditions are usually favourable for hiking trips.

The deaths come just months after 16 Sherpa mountain guides died in Nepal's worst ever accident on Mount Everest.

Nepal's high peaks attract some of the world's best climbers - but trekking is generally safe and appeals to masses of ordinary outdoor enthusiasts