look at the nexxus site, type 3GB enabler, there is an large decription, in short : this programm will adress your falloutNV.exe to use more than 2GB if you have a 32-Bit OS. but when you say that turn off music, reduce resolution and tune down all video options did not helps. then your PC is unfortunately to slow for this game. or you try a clean new installation. sorry !!!