The third wave of the COVID-19 pandemic in Sri Lanka resulted in a rapid rise in incidence and mortality, and overburdened the resources of the free health care sector. This narrative written by a junior doctor who worked at a COVID-19 high dependency unit in Sri Lanka, brings to light the unique palliative care and humanities dilemmas that occur when rising demands of health care surpass the resources of the system. The article will discuss issues of palliation, end-of-life care and family-centred issues in critically ill patients with prolonged hospital stays. It will also discuss the impact of a pandemic on the mental health of front-liners offering both critical and palliative care, which in turn inevitably affects all aforementioned entities. The author suggests strategies to reduce the consequences of these dilemmas on patient care, through improvement of institutional availability of essential health resources based on correct identification of need, equal distribution of frontline work and accessible institution-based services to prevent burnout among health care workers.
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