Once the Fool punches off the mask of Little Death, an eyeball appears as the Fool dodges her attacks and shoots more Winged Skulls. The mass left over then turns into (Death ?) as a winged beast with Little Death's face emerges to try and kill the Fool. After a small freefall, the Fool punches Little Death and has to shoot her heart pieces out of the sky. She then pukes a light blue trail that the Fool rides on. The Fool then punches Little Death 3 times, the first 2 stunning her and the 3rd knocking her down. After the tunnel Little Deaths again spins with her scythe forcing the Fool to dodge, then jump. After a little while longer, Little Death looks back and yawns at the Fool, then jumps up and uses the Tarot Card XIX (The Sun) as she electrifies a tunnel for the Fool to ride through. She then turns around and jumps up as skulls sit by her side, and the Fool has to shoot Little Death's attack Ashwell as the skulls. The Fool starts off by chasing down Little Death, then having to quickly avoid her Scythe attacks as she spins towards the Fool. At the end Little Death is there and is waiting near her motorcycle with a scythe. The Fool rides through Lovedead city stand on her motorcycle as she uses her bow to shoot down the skulls. The Fool then chases Little Death, and at the end of the level, Little Deaths pulls out the card XII (The Hanged Man) as skulls with wings fly out of a portal and fill up the screen. Little Death then jumps up, giggles, then proceeds to put electricity on the outside edges of the road, being deadly to the player.

The Fool is transported to Lovedead City and proceeds to play through the level until they come across Little Death standing on her motorcycle. Little Death can also been seen with a scythe, and riding her motorcycle.

She is wearing an all black outfit with a white scarf around her neck, and has white socks with black and white shoes.

Little Death has short yellow hair and wears a half skull mask on the upper part of her face. She resides in Lovedead City and is the fifth and final Arcanum that the Fool battles.

She and her allies are the main antagonists of Sayonara Wild Hearts. Female Little Death is a cursed Arcanum who is the personification of Death and allies herself with other curse Arcanum to steal all harmony from the Astral Highways and hid it in their hearts.

Sayonara wild heart death