I destroyed the bear, but Lydia was still crouched on the ground dry-heaving. I waited a couple of minutes but she stayed down and didn't recover.
I tried walking away and she started crawling after me on her hands and knees, clutching her side and dragging her shield. It was rather depressing.
There was no way out of it, short of putting her out of her misery myself. I had to reload an earlier save.