This gorgeous necklace features an antique silver registered nurse caduceus charm hanging lariat style from a silver heart charm. With your choice of letter charm. Leave the letter you need in the checkout comment box. This necklace is on silver plated 18 inch chain with a silver lobster clasp. —————————————————————————————————————————- ** US Shipping ** Your order will ship first class mail (2-5 days). ** International orders ** Please allow 5-6 weeks for your international order to arrive. ( 2 weeks for your item to be made and 3-4 weeks for delivery). ***Your Special piece will come ready for gift giving in an organza drawstring bag.*** .