This paper reports a longitudinal case study of a Swiss hospital coping with the COVID-19 pandemic. Leveraging a paradox lens reveals the organizing paradox of contradictory but interdependent expectations in treating both COVID-19 and normal patients. Handling these contradictory demands surfaces a paradox of centralized and de-centralized decision-making. Unfolding the latter to navigate the former, the hospital enacted a so-called "calibration mode", which balances the centralized and de-centralized decision-making to continuously calibrate resources and treatment capacities in order to adapt to the volatile pandemic while ensuring the treatment of non-COVID patients. The study thereby speaks to literature on extreme contexts, as well as to the paradox lens. Regarding the former, we show a novel approach of handling enduring extreme contexts. Regarding the latter, the study advances on the dynamic interplay between paradoxes and response approaches.