Tough as nails to beat, but rewarding every time.
Although I *do* wonder if adding 3 Fatigues to the deck is a bit much. In the later levels (7+) it slows down the gameplay a lot. Less weapons/armor will spawn in, (because of the fatigue cards) and you will have to backtrack a lot to get a decent hit in. That can end up feeling quite tedious.
I wonder if it would be better to either add just 2 fatigues, or to increase the "penalty free" room number in the last 3 or 4 levels to 4, rather then 3.
(Edit: In the run I screenshotted, I had 21 fatigues in my deck, plus the ones on board)