As soon as the first shock of her breast cancer diagnosis faded, Cathleen Carter turned on a key ally in her fight for life: her computer.
Hour after hour after hour, she used the Internet to plumb Web sites and archives to learn more about the disease that threatened to kill her and the ways doctors battled it. Without leaving her study, she heard from specialists and scoured massive research libraries, hunting for every scrap of information that might give her a better chance.
For at least 200 hours since she was diagnosed in February, she has waited for the data to trickle down her phone line into her computer. It was time well spent, she said. "Hey, this is my life."
Besides giving her doctors suggestions about new research or treatments, her research provided reassurance that she was making the best possible medical choices, said Ms. Carter, an Erie County Medical Center psychologist.
Psychologists call it a coping strategy, she said. By focusing on the hunt for information, it can help her handle the crushing immensity of her situation.
"It's a way to deal with it," she said, "instead of just sitting around saying, 'Holy s---, I might die.' "
In the past decade, the Internet has helped fuel a breathtaking expansion of possibilities for people coping with serious illnesses and for their families, in ways that go far beyond mere information.
It has arguably become the largest medical library in the world, bulging with archives and up-to-the-minute medical findings.
It has become a meeting place for people with shared concerns, where people fighting illness can escape their isolation and find support from others facing the harrowing battles.
It also has provided new forums for discussing exceedingly specific topics, places where those seeking answers often can get expert guidance without regard to office hours or insurance cards.
"A patient sitting down at a computer for an hour can find out about opportunities for alternative treatments," said Dr. Thomas Rosenthal, chairman of the University at Buffalo Medical School's Department of Family Medicine. "But they can also reconfirm what their own physicians have been telling them, by consulting outside sources.
"Either way, it's a good thing," he said. "The patient gets more involved in treating their illness, and it increases the opportunity for dialogue between doctor and patient."
There are more than 15,000 sites on the World Wide Web alone focused on medical or health-related offerings, according to recent surveys. How can someone find the help he wants in such a blizzard of information? Because anyone can put practically anything on a Web page, how can innocent searchers tell decent information from dubious?
Handle information from the Internet with the same caution you would any other information guiding your decision on health choices, Rosenthal suggested. Consider the source.
If it's from the American Medical Association site, or a hospital's Web page, it's probably up-to-date and accurate. If it's of unknown pedigree, proceed with due caution.
One cardinal rule, Rosenthal suggested: Before making any serious medical decisions based on Web information, talk to your doctor about it. Most doctors should be able to review information that would change the course of their patients' treatment, he said.
"All in all," Rosenthal said, "I've had a very positive experience with patients using the Internet as a source of information."
Name it. If you have questions about a diagnosable medical condition, surgical procedure, medication or theory, it's all but guaranteed that people are talking about it on the Web.
All you have to do is find it.
Unless you've gotten a specific Web address from your doctor or another source, the road to answers begins with a search engine. That's a Web site that acts as an index of pages or sites on the Web, allowing users to get lists of sites that contain the specific words searchers use, or deal with related subjects.
Then it's a matter of clicking on different sites in the list that look promising to find what you want.
Say you were recently diagnosed with diabetes and want to learn all you can about it. Punching "diabetes" into Alta Vista, perhaps the most comprehensive word-based search engine, instantly gives you an idea of how big this Internet haystack is. There are 663,510 pages indexed containing that word, it says.
Don't panic. On the same page, Alta Vista has an ingenious feature to make searchers' task easier: fill-in-the-blank search forms, sensitive to the context of your request.
The "diabetes" Alta Vista search pops up two questions. One asks what kind of stuff you're looking for: contact information, general information, Web sites or mailing lists? Choose one and click to narrow your search to more reasonable proportions.
It also gives users a point-and-click list of medical conditions in alphabetical order ("DiGeorge syndrome, Down syndrome, Dwarfism, Dysautonomia . . . ") to make instant changes of subject. No typing required.
With each disease, Alta Vista pops up another multiple-choice question form to help refine your search. With diabetes, users are presented with 23 different choices under "Where can I find . . . " including "common concerns with," "complications of," "coping with," "gestational" and "juvenile."
The other major type of search engines are subject-based, where sites are organized by subject, content and provider. Type "diabetes" into Yahoo, and you see 36 categories of related sites, from government services to books and publication, from national organizations to treatment centers.
Depending on the site, browsers can read up on the latest research, ask questions of an expert by e-mail, read and post observations on a Web-based bulletin board, or join a daily e-mail list, sometimes called a "listserv."
Such lists link people of common interest by relaying e-mail messages sent to a central server to each of the list members. Every day, list members can download all of the day's notes and responses to previous mail.
The connections that the Internet allows people to make with others "can be ennobling," said Ms. Carter. After her cancer was diagnosed, sometimes she found herself awake in the middle of the night, reading cancer survivors' accounts of how they battled to maintain their dignity, and their lives, in the face of the disease.
"It's 3 in the morning," she said, "and you know you are not alone."