Fill a pot with water, and set over medium heat to prepare to cook the pasta, following package instructions. (You'll add the pasta to the water around the same time that you add the cream to the sauce mixture.)
Remove sausage mixture from the refrigerator, and with clean hands, form four ½-inch thick patties. In a large skillet, heat oil over medium-high heat, until shimmering, then add sausage patties. Cook until bottom side is light golden brown, about 3 minutes. Using a thin spatula, turn patties over, leaving room in the center of the skillet. Add the onion, lower heat to medium, and cook, using a wooden spoon to crumble the sausage (shoot for ½- to 1-inch pieces), until sausage is just cooked through, and onion is softened - about 2 minutes.
Increase heat to medium-high and add wine. Bring to a simmer, and cook, swirling pan and deglazing the bottom with the wooden spoon. Simmer 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, until sauce is slightly thickened, about 3-5 minutes. Season with salt and pepper to taste, and reduce heat to lowest setting to keep sauce warm and prevent it from over-reducing.
Cook the pasta in boiling, salted water, as instructed on the package, until shy of al dente (about 2 minutes less than the package directions). Use a spider skimmer to transfer the pasta to the sauce, along with the water clinging to the pasta. Reserve about ½ c of the pasta water.
Increase heat to high and cook, tossing pasta and sauce rapidly, until pasta is al dente, and the sauce has thickened. It should coat noodles and pool around edges of the pan in about 2 minutes. Add pasta cooking water as needed to achieve desired consistency.
Remove from heat, then add Pecorino Romano, stirring rapidly to incorporate. Divide between warmed serving bowls, top each portion with black pepper, grated nutmeg, and more cheese. Serve hot.