You have gained the ability to go beyond your normal limitations. You must declare going plus ultra before rolling to hit on a melee attack. You gain advantage on that hit roll and if the attack lands, you deal the maximum possible damage for that attack. The damage is then multiplied by the number of levels of exhaustion you choose to suffer. For example, if you were to attack with a greatsword (2d6 + str) with a strength score of 16, you would deal 15 damage and suffer 1 level of exhaustion (15 x 1 = 15). However, if you choose to suffer 2 levels of exhaustion, you would deal 30 damage (15 x 2 = 30). The multiplier IS NOT your current level of exhaustion, it is the number of levels you suffer for this attack (If your exhaustion was already at level 1, suffering 2 more levels for this attack would put you at exhaustion level 3, but would only give you a x2 multiplier, not a x3!). If the attack would cause you to reach 6 levels of exhaustion, roll 1d4. On a 1 you die, otherwise, you fall unconscious.
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