Having a lot of fun with this still. Started a new character for the second time, now with even more mods to beef up the survival difficulty, combat realism etc. Plus a few handy bits and pieces.
My current character is named Furiosa. Got a laugh when the robot actually said my name at the start. Didn't expect them to have recorded that one, but they had. I guess it would have been an obvious choice after Mad Max Fury Road.
On top of playing survival, modded to be even harder, I am playing semi-iron man. I play with the understanding that dead pretty much means dead. So I don't get into fights that I can't finish.
To balance tension against frustration I have a few ground rules instead of just "any death means end of game".
If I knowingly choose to fight some people who I have the jump on, like a group of super mutants or some raiders, and they then kill me... game over. Exception might be if they kill me in some really lame manner. Maybe I've got them outgunned and they get a fluke shot in and I feel it's really unfair. In that case it just counts as an injury. But if I go commando on a superior force and end up in chunky pieces, then game over.
If I get randomly killed by somebody I never saw who had a rocket launcher, or I step on a mine like an idiot etc., counts as an injury. Same goes for deaths that don't turn me into a pulp involving something lame like a ghoul or a dog, where I can at least come up with some RPish excuse that I was rescued etc. I can't abuse this loophole though to risk my life in an unreasonable manner. If I have a doubt, I generally play it safe.
If injured, I add a scar to my face at the doctors. So far this has happened once. It's not very visible though with my Furiosa style war paint on though. If I can survive in the wastes without any proper death then over time I think my scar count might get pretty high. Should look good. On the other hand if my faces ends up a mass of scars that would suck. So that should help keep me honest and cautious.
I've made it to level 10 so far. Being stealthy, having good perception, and avoiding most serious fights. I've killed about 8 humans, not counting ghouls. My dog has saved my life a couple of times. One very close call with a rad scorpion. Much more tension than with my last player, where I was just dying, loading, dying, loading, pushing through quests. Now I haven't even done the first Concord fight. Walk in there and fight six or seven armed men by myself? No bloody way. Maybe when I'm closer to level 20 and have modded my assault rifle and power armor some more.
Few screen shots...