This was not a heart attack, I insisted, it was stress, in proportions, I admitted, that I had never experienced before. And I told them why I thought so: For the past number of months the firm I was working for had been in the midst of a massive reorganization. Layoffs, department changes, work reassignments, budget changes, rampant rumors, sudden employee departures and much more, had been our daily work diet.

This, I insisted, had to be the source of my symptoms--the culmination of the most difficult work situation I had ever experienced. I had not slept or eaten well in weeks, I explained. I was exhausted, stressed to what was now clearly the breaking point. The attending physician did not buy it.

It turns out we were both wrong. And both right. It was not my heart; it was my gallbladder--so infected that I underwent surgery two days later for its removal. Afterward, the surgeon and I spoke, and he expressed amazement that the symptoms a decaying gallbladder transmits--abdominal discomfort, difficulty sleeping, jabs of pain, diminished appetite, nausea and an elevated temperature, had gone unnoticed.

They had not gone unnoticed, I responded. I had absolutely felt them. Every day. But the symptoms had so mirrored the physical sensations I always felt when under stress, that I had assumed they were workplace generated and would cease when the pounding pulse of the firm's reorganization quieted.

I was under such stress that I had not realized I was actually physically ill as well. Seriously so. The stress was so pervasive, so all-encompassing, I had failed to recognize the danger signs my body was flashing from another direction. Had the stress caused the infection? No. Could I have caught it earlier, if I had not written it off to stress, and been treated without surgery? Quite possibly. I was sobered and stunned, realizing how perilous stress can become and how it can dangerously infiltrate your life.

And while the level of stress that workers are able to tolerate is a highly individual matter, in nearly all instances most of us fail to recognize its power, its danger and our vulnerability to it.

The causes of stress are as varied as the character of the individuals experiencing it, but many common workplace factors, which the majority of us experience to one degree of another, are strikingly clear in survey after survey:

• Technology. The speed that computerization has brought to the workplace has many people working at paces--and work output expectation levels--they are straining to reach and barely able to sustain. The latest term for this is techno-stress.

• Profitability. At a time of historic unemployment lows, skyrocketing Wall Street performance, enormous access to goods and services and impressive disposable income levels, workplace stress levels are higher than ever. The dark cloud behind the bright light of dazzling firm profitability is that profits must be sustained and surpassed, quarter after quarter. And workers are paying the price in the accompanying stress and anxiety levels over losing jobs if performance falters.

• Control. More and more workers are feeling the strains of their distance from vital company decision-making and their lack of involvement and inclusion in core company issues. One of the biggest causes of stress is the pervading sense that the company does not care about me. The lesson stress teaches: 80 percent of work is not what is done, it is how it is done.

• Poor Management. Factors such as unreasonable pressures, cloudy career paths, longer work hours, understaffing, poor communication and a myopic management focus on motivating workers to work harder, cheaper and faster, rather than on more comfortably and humanly, is deepening stress at all levels.

  In addition, placing managers in supervisory positions who have enormous business skill but little "people" experience (a phenomena started in the early 1980's when MBA degrees were viewed as something slightly shy of sainthood), have permeated management ranks with individuals who know business but have no business managing people.

  And the distressing part of working in a firm created and/or by an entrepreneur can sometimes be the acerbic, overbearing qualities his or her management style is seasoned with. On the other hand, some of the stress of being in a large organization comes from the fractured, Byzantine and often arbitrary structure and decision-making process.

• The "If You Are Not Stressed You Are Not Performing" Syndrome. As stress levels increase around them, workers may likely take it upon themselves to increase their own stress levels--consciously or unconsciously--as a means to reassure themselves of their value, their rightful place aside stressed co-workers, and of the importance of their work to the firm. Ever done that? We all have.

• Change, Change, Change. New firm procedures, new computer systems, new departmental or individual responsibilities, new owners, new supervisors, new job responsibilities, new competitors. These and other types of changes are happening more frequently and more pervasively in workplaces than ever before. One of the greatest contributors to stress in this category: poor employee training coupled with a just-get-the-job-done and figure-it-out-as-you-go firm philosophy.

• Longer Hours. Fatigue, burn-out and greatly diminished fitness are often a result. How serious can this situation become? How about confusing fatigue and job stress for a serious gall-bladder attack or for a doctor to be convinced you are having a heart attack?

The Signs of Stress
We all have individual responses to stress. Some people tighten up. Some yell. Some start talking fast. Some grow mum. Some eat, others stop eating. While the physical characteristics are similar or recognizable, the emotional responses can vary greatly. And bear in mind that stress is not anxiety.

Stress and pressure can create or lead to anxiety (like lifting a heavy load can lead to a muscle pull), and that is where individual control and the personal ability to manage stress become vital. Keeping work in proportion, keeping stress in perspective and recognizing (and then responding to) the signs of stress are keys to maintaining health and sanity, and to keeping stress from expanding into something far more serious in your life.

The most common stress-signals? You have probably felt two or three of them today already. Or at least one or two while reading this article. Here is a list of the most prevalent physical and emotional stress responses:

• Fatigue
• Low energy or low enthusiasm for work
• Headaches and/or abdominal discomfort
• Weight loss
• Difficulty sleeping
• Trouble overcoming a cold or other illness
• Irritability/loss of patience
• Difficulty concentrating
• Sweating or shifts in body temperature
• Loss of temper more frequently than usual
• Resentment
• A sense of being ineffective or unsubstantial
• Fear, of losing your job; of displeasing co-workers or partners; of failing, but in proportions that far exceed the apprehensions we all feel about this in our work
• Depression
• Unwillingness to communicate
• Turning to alcohol or drugs

Set and reach for realistic goals. If someone--above you, next to you, or you yourself--sets unrealistic goals or establishes unreasonable expectations, the net result will be stress. And here is where a deeply personal decision has to be made: If you are being treated unfairly or unreasonably--if the stress being placed on your shoulders is more than you want to accept or can bear--you might consider walking away and finding a better way for yourself. Or, perhaps easier to accomplish: Do not be afraid to say no.

Do not be afraid to admit to yourself, family, friends, co-workers, supervisors and others that stress loads have become too heavy. A willingness to bear a huge stress burden is not a barometer of your capabilities or ability to succeed. In fact, one of the most effective stress-reducers you can create is a small inter-office support group, where the pressures, symptoms and apprehensions are mutually shared.

I once worked in an office where approximately 10 employees gathered every morning for the first 20 minutes to talk about the day ahead, about what we might do to make each other's tasks smoother, about the pressures we had gone through the day before. It was wonderful.

Watch your health and exercise. Worry and stress sap energy and dampen interest in exercise, nutrition and keeping fit. The more you exercise, the better you will feel. And as the experts always recommend, learn how to stretch. The number of knots and kinks stress can twist itself into in your body is tremendous.

Find something that relaxes you at least once a day. Listen to music with a headset, meditate, take a quiet walk, read a book that has nothing to do with your work. Find something that enables you to slow down, relax and regroup, or do something that makes you laugh.

Stress is infectious so try to avoid integrating co-workers' stress, especially if you are working together.

Large, complex tasks and projects are stress builders. One way of diminishing the inherent stress is to focus on one phase of the project at a time. Continually stressing yourself by holding up the vast, unfinished project before your mind's eye can make matters worse and be overwhelming.

One system I often use: I imagine a large project is actually a home I am constructing, and I focus solely on one phase at a time: first the foundation, then the framework, then the walls, etc. In short, keep the project in perspective and zero in on one step at a time. It is the difference between eating one bite at a time versus swallowing a whole turkey.

Change your working conditions. For example, try to work at home here and there; sleep late some days and then work late; work for 11 hours four days in a row and take Friday off; do some of your work down the hall in a conference room every now and then. Try not to fall into an everyday rut where your physical surroundings never change; it makes you feel as if nothing is changing or progressing.

Learn time management and project management. These, especially for large tasks, are vital skills. Always keep in mind that to a large degree stress is a matter of choice and that you are fully responsible for your reactions. Question yourself deeply and honestly about why certain situations are causing stress.

There may be more beneath the surface than you initially realize--and it may give you a route to take for diminishing its severity and impact. To a large extent, this involves a serious review of whose expectations you are trying to meet--and why.

And if all else fails, play the lottery.