Your next Fallout adventure begins with an iconic image from the Vegas underworld: a desert execution and an unmarked grave. One robot rescue later – and after some character creation decisions made through the medium of an excruciatingly dull doctor – you're asked a very important question. Would you, in your role as a post-apocalyptic Fedex worker mugged en-route to the Vegas strip, like to continue your travels in hardcore mode? My advice would be that you most certainly would.

Playing Fallout: New Vegas in hardcore mode is a revelation. It feels how its already worthy predecessor was meant to. The vast amount of clutter you can sweep into your inventory starts to make sense, as much of it can be sold. Medicine and the new Survival skill suddenly become central, and the blinking lights of a Nuka-Cola machine can signal your salvation.

For existing Fallout players, it's refreshing just to be forced into a character reboot – after 80-plus hours in Fallout 3, you could critically damage a Deathclaw with a raised eyebrow. But on top of this, the limits imposed by hardcore mode enforce a fresh appreciation for the nutritional potential of your inventory, your health, your addictions, your tactics and your relationships with the inventories of the NPCs around you. It makes you far less blasé about the game's systems, and makes tactical combat (and, at some points, its avoidance) a necessity rather than an occasional dalliance. The fact that your ammo now has weight means that you might become more appreciative of melee weapons, too.

Above all, you'll get to know doctor NPCs a mite better. Sleeping on the stray mattresses you come across, though now a necessity to avoid sleep deprivation, is no longer an instant cure-all, and stimpacks only heal over time. More urgently, only a doctor's bag or a trained physician can heal criticals and broken limbs. A shame, then, that my early reaction to the insufferable dullness of the saintly Doc Mitchell was to go about his face with a nine-iron. He died a hilarious death, if a somewhat unwisely inflicted one in terms of my continued survival.

As with life in the real world, in hardcore mode you need regular access to water. You'll stash and guzzle everything and anything to stave off thirst: beer, wine, spirits, Nuka-Cola and even dirty toilet water. In Fallout 3, your first encounter with a lavatory was to experimentally use it – expecting a standard FPS flush noise – only to be somewhat startled when you heard your character lapping water from the bowl. Back then, you made a mental note never to do that again. Not ever. Yet play New Vegas in hardcore mode and you'll find yourself actively seeking out postapocalyptic restrooms, and positively sighing with relief as you greedily guzzle at the U-bend.

Whether or not you leave Doc Mitchell's house in hardcore mode or as a GP-slayer, there are things you'll notice as you first trot through the Mojave Wasteland, particularly if you've played Fallout 3. For a start, there's the feeling that you're on a new frontier, an active participant in a strange futuro-Western. This cowboy feel is gently introduced in early missions, such as one that has you choosing how to re-instigate the rule of law in a town called Primm – saving its deputy sheriff from escaped outlaws as tumbleweed rolls around beneath a clear night sky.

On top of this, if you thought that bongo, bongo, bongo, you didn't want to leave the Congo and that Fallout 3 radio playlists were a delight, just wait until you hear New Vegas's country and western station, Mojave Music Radio. The satisfaction of scuttling after a Powder Ganger hoodlum who's criticalled both of your legs with dynamite, and managing to hack off his arm with a machete, increases inordinately when it's done to a plaintive southern belle singing, “I'll be your cowgirl, if you'll be my cowboy”.

Something else you'll notice early on (though perhaps not in the opening town of Goodsprings, which is a tad dull) is an overall improvement in characterisation and dialogue. Here, it honestly does feel as though some tenets of the Black Isle legacy are dripping through into the Obsidian melting pot. Sure, dialogue trees remain limited and conversation brief – but through vastly improved voice acting and some genuinely interesting characters, the condensed dialogue feels streets ahead of the often insipid lines Bethesda offered up back in Washington DC.

Some decent examples of this crop up in a mission I played from later in the game, a sequence that takes place in the REPCONN rocket factory entitled Come Fly With Me. This is the cheery tale of a group of ghouls who show some marked similarities to the real-world Heaven's Gate cult, so obsessed are they and their leader Jason Bright with 'the great journey' into outer space. Their associated missions are largely familiar to Fallout 3 players: clear out or placate the gribblies occupying the basement; fetch this; fetch that; go and see if so-and-so is dead; push this button; watch the fireworks... the usual jazz.