At age 56, Stephen Schneider was at the peak of his career. A widely published, globe-trotting climatologist at Stanford University, his many honors included a MacArthur Fellowship genius award.

Then he was dealt a stunning a setback: Doctors diagnosed him with a rare cancer of the lymphatic system -- mantle cell cancer. "I was scared to death," he writes.

But, like an increasing number of patients, Schneider and his wife tried to take control of his case, researching his disease and debating with doctors about proper treatment. His account of this journey, "The Patient from Hell," is a vivid and inspiring story. It is also a wonderful teaching tool: If you or a loved one become seriously ill, it can help you manage your case.

Schneider's account is part of a growing number of books -- including "His Brother's Keeper" by Jonathan Weiner and "All in My Head" by Paula Kamen -- that describe a new kind of patient or patient advocate. Instead of just "going to the doctor," patients now are also going to the Web, joining chat groups and support groups, even ordering drugs from Mexico or India. They are creating a new and welcome subgenre of illness narratives (so-called pathographies) that emphasize a patient's role in treatment.

While Schneider's narrative is lively and engaging, there are several important thematic points for patients with any serious disease to consider:

* Persevere: Part of the battle is keeping going in spite of all the obstacles. Schneider emphasizes taking care of emotions such as rage, sadness and consternation.

* Be assertive: "Remember," he writes, "your doctors are merely mortals, albeit busy ones, and your concerns should be theirs. It is possible to approach them in a polite-yet-firm manner. ... When your life is on the line, there's no room for backing down or settling for second best."

* Challenge doctors about treatment options or have an advocate who is willing to do so. Few patients have the technical expertise that Schneider and Terry Root (his wife, a biologist) brought to his ordeal, but even a family member or friend can write down what the doctor says, ask questions, and use Web resources (he lists 15 for cancer at the back of the book).

* Participate in your care by using what Schneider calls the "precautionary principle," in other words, guarding against the worst case. We do this routinely by buying health insurance. If we are very sick, we might consider preventive or maintenance therapy, as does Schneider, always staying alert to ways in which we are not the "average patient" that medicine often assumes we are. We need to guard against care -- including medical errors -- that is not appropriate for us.

* Ask for the most recent medical knowledge and individualized treatment. Large data sets of statistics (traditional "evidence-based medicine") may not apply to each of us as individual patients, for whom there may be different factors (like side effects) and for whom other than standard treatments may be most helpful and efficient economically. Here Schneider challenges what he calls 19th-century thinking that has been codified by insurance companies, HMOs, drug companies, governmental policies and some traditional medical education. All of these make a difficult arena for the delivery of medicine, especially for progressive doctors who want to think speculatively and deliver individualized care to patients.

This is a clear, dramatic and very informative book; it tells Schneider's story from diagnosis through various treatments to an ongoing remission (he is on a hard-won maintenance therapy). For some readers, it may be somewhat scary, because Schneider describes vividly his bone marrow biopsies, chemotherapy, radiation treatment, side effects, and emotional turmoil. As a fellow cancer survivor, however, I can attest that these are accurately and sensitively told.

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