Started playing Fallout 4 on survival mode, with a vegetation mod. It's a very different experience.
Survival is very punishing though. Pretty much always going around with serious stat reductions from diseases, thirst, hunger, and not sleeping 8 hours per day.
Worst is you only save when you go to bed. So if you die, you can lose a whole in-game day of progress. Wandering around looking for a mold and flea ridden mattress just so you can quit the game and getting a damn disease from your naked skin being in contact with all that yuck is a special feeling.