I kept crashing before I could even hit PLAY on the menu. Got an appcrash and couldn't do a thing with this game. So I deleted the C:\Program Files (X86)\Stean\Steam Apps\Common\Fallout New Vegas content in the directory and restored from a backup that I did when I first installed the game. Then I told Steam NOT to auto update the game. Now it runs. The patch really borked the game from even running.

some system info

EVGA GTX 470 with GeForce 260.89 WHQL
X58 motherboard with i7 950 (not overclocked)
Windows 7 Home Premium 64 Bit
Creative Soundblaster X-Fi Extreme Gamer Fatality Pro sound with most up to date drivers

All software totally updated all the tme. It has to be the patch. Perhaps Bethesda needs to reconsider either pulling back the patch or release something right away to fix the patch from today.