Integrating palliative care into the surgical and trauma intensive care unit is challenging. The nature of surgical illness, practice patterns of surgeons and critical care nurses, and the culture of the intensive care unit all suggest that familiar models of palliative care do not apply in this setting. We describe a novel interdisciplinary model of palliative care in the surgical intensive care unit, which addresses communication, shared decision making, and pain and symptom management for all critically ill patients, regardless of prognosis. This communication-based model integrates new processes of care into existing surgical critical care practice so that palliative care can be provided in parallel with surgical care.