When I was doing my initial brainstorming about running The Blight, I did a lot of thinking about how to make 5E more deadly and grimmer. But my players decided that they wanted to do Swords & Wizardry so I’m cool with that. But I still had these ideas. so I figured what the heck share them.
I wanted to do something that fit within the existing rules and didn’t screw around too much with everything else. For lack of better terms, I came up with two ideas. Let’s call them strategic and tactical.
For strategic, I’m thinking long term effects of game play over the campaign and this one is pretty simple. Slow down character progression. Keep the characters at lower levels longer. I’m thinking about twice as long. This keeps those low-level threats still threats even longer. And the higher level ones be even more dangerous. Simple.
Then for the tactical side. This for something that actually effects the characters as they are adventuring. I didn’t want to mess with long and short rests. Heck. Let those stay the way they are. There’s a lot of class abilities that are tied to those and I didn’t want to mess with all that. I didn’t want to nerf the healing abilities because there are so damned many. So I started thinking and flipping through the Players Handbook for ideas. Then it struck me. Exhaustion. And here’s what I come up with.
For each failed Death Save, the character takes one level of Exhaustion.
Sure a character can get all their HP back but they ain’t going to feeling that great. This becomes really dangerous when you break it down and the following isn’t stuff I’m making up. It’s right there in the PHB. At 6 levels of Exhaustion, the character dies. For levels 1 to 5, the character has more and more penalties as their combat capabilities are reduced. A Long Rest recovers one level of Exhaustion. A Cleric can “heal” one level of Exhaustion with Greater Restoration (A fifth level spell).
And that’s it.

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