Pasta Alla Norcina Is Creamy and Rich (With or Without Truffles)

For the Sausage Mix: In a medium bowl, combine pork, garlic, salt, pepper, and nutmeg and stir with a wooden spoon to evenly distribute seasoning. Add 2 tablespoons (30ml) chilled wine and stir vigorously with wooden spoon, working meat mixture against bottom and sides of bowl, until wine is incorporated and mixture becomes tacky and sticky, 1 to 2 minutes. Cover and refrigerate for at least 1 hour and up to 2 days. Alternatively, combine pork, garlic, salt, pepper, and nutmeg in bowl of a stand mixer fitted with the paddle attachment. Mix on low speed until seasonings are evenly incorporated, about 1 minute. Add wine, increase speed to medium, and mix until wine is incorporated and mixture becomes tacky and sticky, 1 to 2 minutes. Cover and refrigerate for at least 1 hour and up to 2 days. For the Pasta: When ready to cook, remove sausage mixture from refrigerator and, using clean hands, form into four 1/2-inch-thick patties (don't worry about making them perfectly round as they will get broken up into smaller pieces; if using store-bought sausage, form uncased sausages into 1/2-inch-thick patties). In a large skillet or straight-sided sauté pan, heat oil over medium-high heat until shimmering. Add sausage patties and cook until bottom side is light golden brown, 3 to 5 minutes. Using a thin metal spatula, turn sausage patties onto uncooked side, leaving an open area in the center of the skillet. Add onion, lower heat to medium, and cook, using a wooden spoon to break up sausage into 1/2- to 1-inch pieces, until sausage is just cooked through and onion is softened, about 2 minutes; lower heat at any point if sausage or onion threaten to scorch. Increase heat to medium-high and add wine. Bring to a simmer and cook, swirling pan and scraping up any stuck-on bits with a wooden spoon, until wine is reduced by roughly half, about 30 seconds. Add cream, bring to a simmer, and cook, stirring frequently to keep cream from scorching on sides of the pan, until sauce is slightly thickened, 3 to 5 minutes. Season with salt and pepper to taste and reduce heat to lowest possible setting to keep sauce warm and prevent it from over-reducing. Meanwhile, in a pot of salted water, cook pasta until just shy of al dente (about 2 minutes less than the package directs). Using a spider skimmer, transfer pasta to sauce, along with 1/2 cup (120ml) pasta cooking water. Alternatively, drain pasta using a colander or fine-mesh strainer, making sure to reserve at least 1 cup (240ml) pasta cooking water. Increase heat to high and cook, stirring and tossing rapidly, until pasta is al dente and sauce is thickened and coats noodles and pools around edges of the pan, about 2 minutes; add more pasta cooking water in 1/4-cup (60ml) increments as needed to achieve desired consistency. Remove from heat, add Pecorino Romano, and stir rapidly to incorporate. Divide between warmed serving bowls, top each portion with a grinding of black pepper, grated nutmeg, cheese, and truffle (if using). Serve immediately.