Yop!
[quote=Nuketastic]"I have used New Vegas Configator to set interior buffer, exterior buffer, and preload size limit to the max value."[/quote]
I wouldn't recommend it. You should start by revert those values to default, especially if you are using ENBoost. (which is include in the last Enhanced Shaders by Tapioks)
Did you raised the "Ugridtoload" too? If you did, it could/will cause some troubles like CTDs.
I guess it's this tool:
New Vegas Configator by "Rudolf Enberg" http://www.nexusmods.com/newvegas/mods/40442/
If so, it's not so new
18 July 2011 but I believe it works great.
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[quote=Nuketastic]"I am also using 4gb launcher...... and Sheson's memory patch." [/quote]
Tapioks doesn't recommend to use the 4GB loader with his last ENB preset because it could degrades your performance. He wrote this in his read me 
If Sheson's memory patch and ENBoost are already in charge, it's really not recommended to use 4GB loader at the same time.
I think there's too many things that tries to manage your memory and display. Try to use only ENBoost, with or without an ENB preset and Sheson's memory patch. It should help.
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[quote=Nuketastic]"ENB enhanced shaders"[/quote]
I guess you're using the very last version of Enhanced Shaders?
ENHANCED SHADERS - ENB 249 by "tapioks" http://www.nexusmods.com/newvegas/mods/49882/
If so, be sure to set some proper values into enblocal.ini otherwise it could cause some of your troubles.
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[quote=Nuketastic]"and the Nmc's fallout new vegas/3 texture pack that I have optimized"[/quote]
To me, you shouldn't optimize them. It could improve performance but if you did only one bad move during the process... It could brings more trouble than it will solves. Just trust your modders :)
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[quote=Nuketastic]"I have the fake full screen thing on already"[/quote]
If you're using ENBoost, again which is include in ENB Enhanced Shaders, you don't want to use FakeFullScreen mod anymore. ENBoost provides all you need to do this and it's highly not recommended to use them both.
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[quote=Nuketastic]"both bashed and merged patches"[/quote]
You may want to use only one of them. Both are not really working the same way but they will do something very similar. Maybe someone with better information will explain this, I don't want to told you something wrong.
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Here's some useful links:
Fear & Loathing in New Vegas by "EssArrBee" http://wiki.step-project.com/User:EssArrBee/FalloutNewVegas
Fallout New Vegas Optimized by "AdayDr1en" http://www.nexusmods.com/newvegas/mods/46302/th (You really don't want to skip the read me with this one)
Zan AutoPurge Crash Protector - New Vegas Edition by "ZanGS and Luke Gevaerts" http://www.nexusmods.com/newvegas/mods/49319/ (Again, be sure to read the read me)
STEP for Skyrim http://wiki.step-project.com/STEP:2.2.8
(Even if it's for Skyrim you'll find everything you need to setup ENBoost in the very first part of the guide. Do not add any new lines into enblocal.ini from Enhanced Shaders! You have to modify only the lines that are already there. I don't believe it will break things if you do but ENBoost for Skyrim and ENBoost for FNV are not really the same, so if you put some lines from Skyrim into FNV, it won't do anything or worse...)
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If you need any help to set some proper values for ENBoost, just ask. I hope this will help 
Video games are bad for you? That's what they said about rock'n'roll...