First design in is pretty awesome. A few clarifications.
I want the tattoo on my whole chest.
Sand timer in the middle.
For medical logos I prefer to stay away from a basic star of life. There’s one for Tactical Paramedic that is okay and could be used.
Medical staff should be done in an aggressive way with snakes.
This tattoo is symbolic to me of feeling like I am fighting death sometimes.
My follow up tattoo will be going behind the reaper down my left arm and composed of the skulls that the reaper has taken from me. That’s probably a few months away, I’m expecting this tattoo to take a long time in the chair so I may want a break before finishing it off, and I’m not sure exactly how I want the dead to be represented yet.

I’ll try to add some pics

I added some pics. And a public post with some clarification. Thank you.

Edge design sent me another great attempt but not quite there. More clarifications.

Area available for the tattoo - top of shoulders to just above the nipple line, but it could extend to the bottom of the sternum in the center of my chest.
Side to side - armpit to armpit and could even wrap under a little would be fine.
(This is the available area, it doesn't have to completely take up this much space, but it should fill most of the chest)

Edge added body armor, and I was not too fond of it on the med man. Also, NO COVID Masks. This tattoo has nothing to do with COVID.

I might like some mirroring of the characters as if they are both leaning into the battle over time.

The Caduceus could be done large in the background and have the characters layed over it.

I will add some money to this project for anyone that puts good work in, and their work isn't chosen; I just don't know how to do that yet. Maybe I'll do the two or three winner thing if I get some good works.