It could be you. It could be me. Ten minutes away from home, one night something goes wrong and we end up at the emergency room of the nearest hospital. Crowd. Cries. Blood. In pain, we enter the world of misery. Doctors, nurses, suicide attempts, broken legs, overdosis, heart attacks, gunbanging victims, drug addicts, and someone like me :p.

Perhaps almost all of us have seen the hit TV show "ER". The show that has sparked an almost voracious interest in the fascinating, 24-hour-a-day, non-stop world of emergency medical care. But watching is not the same as experiencing the ER, emergency room.

For many of us, a visit to the emergency room can be a stressful, or even scary, event. It is like entering a new realm with no knowledge. There is a fear of not knowing what is wrong with you. There is a fear of having to visit an unfamiliar place filled with strangers, some of them are sick/injured. Also, you may have to undergo tests whose names you cannot even pronounce and do not always mean what you think it means. Like Cat-Scan doesn't actually mean you are being scanned by or with a cat. Ultrasonography doesn't actually involve any flashy ultra light like in Startrek movie, but more like playing with cold transparent Jell-O. And anything ended with coffee — endoscoffee, laparcoffee, and colonoscoffee — doesn't actuall involve any cappucino or expresso, let alone affogato (oooh). Ouch, apparently the suffix is copy and not kopi aka coffee.

I am not an exception. I don't enjoy a visit to ER. I, however, always got interesting stories from each of my ER visit. Unexpectedly landed at the ER here in Tempe, Arizona, recently, enables me to compare it with my other ER experiences. I managed to observe similarities and differences of ER in three different countries in three different continents. Indonesia, the Netherlands, and the United States. While their missions and procedures are similar, the applications and practicalities are so different. Differences in paces and styles are particularly distinct.

In the Netherlands, ER looks very neat, clean and in order. Doctors and nurses do not look panic nor rush. They maintain a very consistent look and style, no matter what happen to you, half-dying or fully-dying. Nurses and doctors are mostly friendly and nice and know what they are doing. They are never overtly friendly and always look "in-order". The patients too, while some look nervous, stressful and in pain, they mostly manage to control themselves. Well-behaved. Very little facial expression and not so much shouting and crying in the waiting room.

Dutch doctors are particularly careful about making medical analysis. They would only come with prognosis after performing some preliminary observation and preliminary tests. Final, or even tentative, conclusion on what's wrong with you, will come up in nobody-knows-when time. Dutch free health care system is great, but it slows down everything to the max. Dutch hospitals mostly have great modern advance facilities. The latest ones. They try so hard fo accommodate everyone on the level of priority basis, but since they also struggle to push down the cost, the facilities are a bit scarce and thus the scheduling system is kinda cumbersome.

In the United States, things can go much faster. Once you check in at the ER, after waiting for sometime — hours if you're unlucky — basic tests and examinations are performed quickly. If you need further tests, then no matter how long it'll take, you'll be stuck at the ER until all tests are done and doctors get and examine the results. Whether it is 3, 4, 5, or more tests, American ER will squeeze them in one very short period, and you'll be forced to wait for your results — for hours — no matter how exhausted you are. It is almost like going into a long tunnel with so many machines and needles, in a high speed train that brings you nowhere and sometimes stuck in the middle. My experience shows that what took me 10 days in the Netherlands are done only in 10 hours in the United States.

American ER always looks busier than the Dutch one. Not always because there are more people in the American one, but also because people move quicker. American doctors and nurses walk faster, almost like running all the time. They are so friendly and nice, sometimes overtly nice. It feels like a perky world. Patients who come also various expressions and styles, range from those who are uncontrollaby expressive and show all the pain to those who are unbelivably independent and relax. Many people come to ER by themselves, without any family or friends. I saw one old guy, perhaps in his 80s, almost fainted because of running out of insulin, drove to the ER by himself. Something like that would not happen in Indonesia.

In Indonesia, ER looks more horrible than those in US or the Netherlands. And very crowded, too. One sick/injured person can be accompanied by the whole family, or the whole kampong !! Even if you close your eyes you can still feel the misery. People cries and shouts and even recite prayers loudly. Sometimes some people who are in pain they ask for God's forgiveness again and again. Something that is almost impossible to encounter in Dutch ER. Indonesian nurses and doctors are mostly nice and friendly, or, perhaps a better word is, sweet.

Just like Dutch and American ones, Indonesian ER is also reasonably fast in giving first help. Interestingly, doctors can ome with prognosis, and even final conclusions, in much much faster time than Dutch or American ones. Not always, but many times, doctors can conclude that you have typhoid fever, hepatitis, dengue fever, gastritis, ulcers, etc., in no time, without performing any tests, not even blood tests! Magic, isn't it? It does not take you 10 days, not even 10 hours, to know that you suddenly have a severe illness or even terminal illness! Whether you really have it or not, that's another matter :p

While technologies and medical sciences used in all of these mentioned places are almost identical — Western medical science and machineries — these science and technologies are located in certain cultural context. They are culturated prior to their uses at the ER. The (Western) concept of ER itself has been contextualized and culturated within the social settings in certain place. And a set of social actors — human and non human actors — are playing a great role in shaping and reshaping ER as a social and cultural artifact. The ER too shapes how doctors, nurses, and patients behave, act, and interact in the ER setting.

So, ER is ER. But ER here is not ER there. ER too, just like any other artifacts in the world, has culture and is culturated, as well as socio-culturally constructed.

image: "The Emergency Room" by Jose Perez, courtesy of US National Library of Medicine.

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