The way to do this today is to do it outside of node. Using an overlay fs with the overlay being a ramfs. You can even chroot into it if you can't scope the paths you need to be just downstream from some directory. Or, just use docker.

making that work cross platform is pure pain

yes and no. Waiting 40mins for every test run is pure pain, platform specific ramfs type mounting is quite scriptable. Yes some devs might need to install a dependency, but its not a complex script.

What are the other OS? There's a bunch of solutions described on Wikipedia

https://en.wikipedia.org/wiki/List_of_RAM_drive_software