After spending more than a thousand hours playing Fallout: New Vegas, a YouTuber called Many A True Nerd decided to do one more run of the game. But it wouldn't be any old type of playthrough. This run would be a challenge, even for a Fallout master that knows the game like the back of his hand.

Permadeath—that is, playing with a single life; all death is permanent—seemed too easy. Playing with hardcore mode, which requires you to things like eat and sleep along the way, also didn't seem hard enough.

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"I wanted to find a way to make Fallout: New Vegas fresh for me again, because I know this game insanely well," Many A True Nerd said in a YouTube video. "I felt like any playthrough wouldn't be hugely challenging for me...I know this game so well, I know all the exploits and how to manipulate it quite well...I wanted to do something that would completely change the way I had to play this game...I felt that ultimately, the complete removal of healing from the game, having every single bullet that hits me be a permanent mark against me, I felt like that was the way to do it."

And that's how Many A True Nerd's "You Only Live Once" playthrough was born. The rules were simple: absolutely no healing. No sleeping, no items that buffed health, no recovering from radiation. No companions. A single healthbar that could never be replenished—that's it.

"It's probably not possible," Many A True Nerd said. "It's going to be a nightmare."

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The run started on YouTube in September 2014. Now, five months later, the run has been completed—he actually managed to beat the game on a single health bar. Perhaps that's not surprising, given that this is the same guy that tried to kill everyone in Fallout 3.

You can watch the first episode of the YOLO run here:

The character was appropriately named after the concept of the run:

As for the build, Many A True Nerd focused on endurance—since that determines hit-points. Every point of endurance is an additional 20 hit points. He also prioritized intelligence, as pretty much any type of Fallout character would—more skill points! And, he gave himself some luck. Just for kicks. He was going to need it.

After giving himself the good-natured perk, he chose his tagged skills. Given that this run makes health very precious, he opted for two non-combat skills. One would hopefully let him talk his way out of things. The other would be to help him go under the radar—he wanted to avoid confrontation if possible.

In the first video, you see Many A True Nerd scrambling to find good armor. So, he scavenges. There is one benefit of a no-heal run: he can sell Stimpaks, which fetch a pretty penny. This lets him immediately raise 700 caps, which is enough for decent armor in the early game. As he explains it, damage in Fallout: New Vegas is special in that, if your armor is in really good condition, you take almost no damage from enemies. You need to wear good armor relative to the damage you're taking in that moment.

But, even with decent armor, the playthrough was still a challenge. Thing is, playing like this means never trying to be a hero. As an example, there's a mission at the start of the game that tasks you with saving a woman. If you don't hurry, enemies can kill this woman, easy. For most people, saving this woman is simple—I mean, it's one of the first things you have to do in New Vegas. But instead of rushing to her rescue, Many A True Nerd stayed back, and let the friendly NPC accompanying him to take care of the situation—even though this potentially meant losing extra XP. But the extra XP would mean more danger, which he didn't want. The woman, thankfully, doesn't end up dying...but only barely. She walks away limping, near death, after that part of the mission ends. But then again, in time, she'll probably heal. Many A True Nerd can't. Again: this is an early mission.

Things only get better from there, at least for the viewer. The entire playthrough is tense and unnerving because any damage—no matter how minor—will add up. Even small amounts of radiation seem excruciating to watch. As a result, you see Many A True Nerd freaking out about enemies that would be minor in any other type of Fallout playthrough. Even simple things, like fast-travelling, pose potential dangers. What if there's an ambush? What if there's someone waiting for you behind a door? One of my favorite moments sees Many A True Nerd making his way through a radiation infested cave, in the hopes of finding a gun that grants a good damage multiplier to sneaking crits. He ends up using a Stealth Boy just to stay clear of rats. RATS. In this playthrough, even a lowly rat is as terrifying as a super mutant.

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But according to Many A True Nerd, the most tense moment had to be the section where he goes through the Boomer Bombardment.

"For anyone who doesn't know, this is effectively running across a target range while people shoot rockets at you—which are easily strong enough to kill or cripple you," he recalled. "There's supposed to be a way through the range you can follow, but it's not entirely reliable - I've been hit in 'safe' spots before. So in the end, I snuck round to the best location I could find (and that involved sneaking through a tunnel filled with ghouls and radiation), dosed myself up with drugs, and sprinted across open ground. I have never been more nervous in a game before."

Still, through careful playing, and lots of sniping, Many A True Nerd goes three episodes before actually accruing damage. The first enemy that manages to land a hit on him is...a dog. Yeah. It's kind of hilarious.

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Curiously, along the way Many A True Nerd learns that the game actually features a veeery tiny auto-healing mechanic. Most people won't notice it, but, every 3 hours, characters in New Vegas regain 2 hit points. Dedicated to his cause, Many A True Nerd decides to keep a "real" health counter, that keeps track of how much HP he would have without the game's help. He tallies it throughout the entire run, with the intent of quitting the game should his "true" health bar ever reach zero.

"This game is too damn soft for its own good," Many A True Nerd said.

The run is also interesting because Many A True Nerd doesn't necessarily try to play as a 'good guy.' In fact, early on, you see him murdering an innocent NPC, just to get better armor. Later on, he tries to game the faction system to try to make sure nobody sends hit-squads after him. It's the sort of meticulous playthrough that's fascinating to watch, because it requires such profound understanding of how Fallout: New Vegas works. You're bound to learn something about what makes the game tick while watching.

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"This run was about 40 hours in total so far," Many A True Nerd told me. "Given I've cautiously avoided some quests, I'd normally expect the same path to be maybe 20 hours - playing this cautiously turns some areas you'd normally charge through into terrifying stealth sections!"

This also makes up part of the run's appeal: it's seeing the game being played in an entirely new way.

"I think it was Zero Punctuation that once pointed out most games with ongoing choices might as well lock you into a path at the start of the game, because you do either the 'paragon' or 'renegade' run - you make your decisions based on what the most appropriate thing to your run is, and stop thinking about any choice; paragon run means always choosing paragon options," Many A True Nerd said.

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"When you're maybe 5 gunshot wounds away from death, your thinking suddenly changes - pragmatism overrules everything. You find yourself changing loyalties, assassinating characters you like, and making alliances based purely on how far it helps you survive. Very few games present you with a scenario where cowardice, treachery or collaboration are paths you're best served by taking. That's what made no-healing permadeath such a fascinating experiment - I've never done a Fallout run where I would have made this combination of choices before."

In the end, Many A True Nerd goes through the final level of New Vegas without taking any damage. It's incredibly impressive. Overall, he finishes the game with half of the health he started with: 260 health out of 445.

"I didn't think I could do it," he said. "I thought I was gonna die." Thankfully, he didn't.

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You can watch the entire You Only Live Once playthrough of Fallout: New Vegas here, as well as check out Many A True Nerd's Patreon here.

To contact the author of this post, write to patricia@kotaku.com or find her on Twitter @xpatriciah.