Prep the ingredients per the instructions above.
Preheat the oven to 400°F (205°C). Cook the sausage, nicely browning on all sides, to an internal temperature of 150℉ (65℃) using a thermometer. Set aside to rest. Slice before using.
In a saucepan or Dutch oven, melt the butter over medium heat. Add onions, garlic, and red pepper flakes, season lightly with salt, and cook, stirring frequently, until onions are very soft but not browned, about 15 minutes; lower heat if needed to prevent browning.
Add tomato paste and cook, stirring, until tomato paste is fragrant and thick, about 3 minutes. Stir in the crushed tomatoes. Bring to a simmer, stirring often, until the sauce has thickened slightly and built flavor, about 10 minutes. Stir in the cream and continue to simmer. Season with salt to taste.
For the croutons: Drizzle the oil over the croutons. Toss until evenly coated. Spread in a single layer over the baking sheet and bake until golden brown and crisp (about 6 - 10 minutes). Then set aside.
Make the Caesar dressing: In a small bowl, whisk together garlic, dijon, Worcestershire, lemon juice, and red wine vinegar. Slowly drizzle in extra virgin olive oil while whisking constantly. Whisk in parmesan. Season with salt and black pepper to taste.
In a medium pot of salted boiling water, cook pasta according to the directions on the package. Drain well and reserve 1/2 cup of pasta water.
Toast the bread. Then spread with butter, garlic, and cheese. Broil until the cheese is melted.
Mix the romaine with dressing and croutons.
Slice the sausage. Stir the vodka, pasta, and sausage into the sauce until fully incorporated. Remove from heat and stir in cheese until thoroughly incorporated into a smooth and creamy sauce. (add reserved pasta water if needed to thin the consistency of the sauce). Season with salt to taste as needed.
Portion and serve with salad, bread, and sparkling water.