TORONTO -- Several months into his tenure as the Toronto Blue Jays' new manager, Charlie Montoyo sat in his office chair, discussing the series ahead against the San Francisco Giants.

Montoyo's office inside Rogers Centre is small and tidy, devoid of clutter. An autographed Andrew Katz painting of Herman Oliveras, Montoyo's favorite salsa music artist, hangs on the wall adjacent to his desk. A set of large conga drums stands along the back wall, a smaller set of bongos atop his desk. They aren't simply decor; when Montoyo was a coach with the Tampa Bay Rays, center fielder Kevin Kiermaier says, he would often find Montoyo sitting in the equipment room, hammering away on the bongos.

Hanging on the wall behind Montoyo's desk is the Blue Jays' full season calendar. Each series, home and away, is highlighted, and he points out the number of days until his family arrives from their home in Arizona -- just over a month to go. "People have no idea," Montoyo says, referring to how much he has to be away from his family. "They think, 'Oh, wow, [he's in the] big leagues ... but almost as soon as they get to Toronto once their school year ends, we go on the road," Montoyo says, chuckling, as he shakes his head.

Instead, he sees his family every day in photos. After spending 21 years managing throughout the minor leagues and then serving, most recently, as Tampa Bay's bench coach, Montoyo was hired in October to lead the Blue Jays. It's his first big league managing job. Montoyo has four photo collages on his desk in Toronto of his sons -- 11-year-old Alex and Tyson, 16 -- and his wife, Sam, whom he met nearly 20 years ago while he was managing the Charleston RiverDogs.

But there is one photo Montoyo keeps hidden from view, a framed 4-by-6-inch image inside of his armoire. He takes the picture out when others aren't around, he says, as a reminder to himself.

The photograph shows Alex, just before his fifth birthday, lying in a hospital bed in the intensive care unit, a stream of tubes and IVs protruding from his body and his head. He is sedated, mouth open, eyes closed, a peaceful expression on his face.

"I keep this picture here to remind me how lucky I am," Montoyo says.

The photo also brings perspective: of what he has lost throughout his journey in baseball -- namely, time with his family -- but also of what he has gained in an extended family that stretches far beyond the field.

Minutes after Alex was born in Tucson, Arizona, on Oct. 17, 2007 (which was also Charlie's 42nd birthday), doctors diagnosed him with Ebstein's anomaly, a rare but serious heart defect in which one of the heart valves doesn't function properly. He was immediately medevaced to Phoenix Children's Hospital, and doctors feared he wouldn't survive the trip. ESPN published a story about Alex's heart condition in 2008, while Charlie was managing the Triple-A Durham Bulls.

Scott Cahalane and his older daughter, Ashley, read the story the day it was published, on Father's Day 2008. Scott, his wife and their three children lived in Buffalo and had tickets to the Bisons' Triple-A game that evening. Scott explained to Ashley that Montoyo would be the manager for the opposing team. A few hours later, she handed Scott a homemade card. "I made this for the guy in the article," Ashley, then 10, said. "Can we give it to him?"

On the front, Ashley had drawn a baseball bat, ball and glove. Inside, she'd written a message: "Happy Father's Day. Since you can't be with your family today, you can be a part of ours."

At the game, after both teams had finished batting practice, Cahalane walked down to the dugout. He asked a player to see if Montoyo had a few minutes to talk. Montoyo walked up the steps and Cahalane introduced himself. The two chatted before he handed Montoyo the card. Montoyo read it, slowly. He smiled and gave Ashley a hug, telling her, "Thank you. This is wonderful." Says Cahalane: "We were just two strangers, but you could see it made an impact."

Montoyo asked if the family could come back the next day; Cahalane replied that they could, and Montoyo left them game tickets. They talked again before the next game, and Cahalane says he promised he and Ashley would be back the following year for the Bulls' series against the Bisons. Montoyo gave Cahalane his contact information, and the two exchanged emails throughout the year. Their friendship grew as they corresponded about their families, jobs and lives. Cahalane travelled frequently for work, and the two commiserated over having to spend time away from their families.

Alex spent the first few years his life in and out of hospitals. His first surgery was at Phoenix Children's Hospital when he was only a week old. He spent a month at Phoenix Children's before being transferred to UCLA Hospitals in late November 2007 for a transplant evaluation. Sam and Charlie drove to UCLA on Nov. 18; on Nov. 20, Tyson turned 5. His parents had to miss his birthday (though his grandmother hosted an "amazing party" for him, Sam says).

At UCLA, Alex remained in the ICU as doctors evaluated his shunt, which had been implanted at Phoenix Children's. They determined it was too big, so surgeons shrunk the shunt in another open-heart surgery, in December 2007. Alex remained in the hospital for three months.

At 18 months old, Alex returned to UCLA for his third open-heart surgery. Through this one, known as the Glenn procedure, doctors rerouted Alex's circulatory system to allow for the blood from the top half of his body to bypass the right side of his heart.

Each time Alex had a surgery, or if his team had a rare off day, Montoyo would fly back and forth from Durham, North Carolina, scheduling a red-eye return flight so he could be at the ballpark the next morning. When Alex needed another surgery, this time on his stomach, in May 2008, Charlie missed a game for the first time in 16 years. He flew across the country and back within 48 hours for the procedure, all on no sleep.

Sat down with Charlie Montoyo in his office today. And no, we didn't talk Vladi Jr... We just had a little salsa fun! This is how he relaxes! Hoy con Charlie Montoyo no nos pusimos a hablar de Vladi... nos divertimos con el gran José Alberto "El Canario"... ¡Qué talento! pic.twitter.com/0a9bbxVXtb

— Marly Rivera (@MarlyRiveraESPN) April 24, 2019

Still, Montoyo rarely talked about Alex's heart complications around the team.

"Us players had no idea what was going on, because he kept it so hush-hush," Kiermaier says. "He probably thought about it every second when he was at the field. But the way he balanced that out and never brought a sad or negative attitude, that's Charlie, 24/7. He's the absolute best."

Montoyo's demeanor wasn't always so calm. Prior to Alex's health scares, Montoyo's fiery personality showed on the field when he argued calls and ripped up lineup cards. But almost losing his son brought about a changed perspective -- and a new leadership style.

Before Alex's final major surgery at UCLA Medical Center, in 2012, Cahalane emailed Montoyo to ask who from his family would be there. Sam's father, John Startt -- who is also Alex's blood donor, as they are both Type A-negative -- and Charlie's cousin, Jose Montoyo, were the only other family members present, Charlie told him, beside Sam, Alex and himself. (Sam's mother, Suzanne Startt-Wilkes, stayed home with Tyson).

So Cahalane, who travels frequently as part of his work for a software company, bought a plane ticket and flew to Los Angeles. He landed while Alex was in surgery and, a short while later, texted Montoyo from the waiting room: "I'm here. You don't need to come down, but if you need something, I'm here." After the surgery, while Alex was taken to another area of the hospital, the Montoyos met with their friend.

"It was really, really nice," Sam said of Cahalane's impromptu arrival. "Sometimes it's nice to have someone to sit in the cafeteria with, someone who knew us well enough to know that now is not the time to ask me stupid questions. Just sit there with me and be there and be supportive. It was very thoughtful."

A few years later, following a long road trip for the Bulls, Cahalane flew Sam, Tyson and Alex to Buffalo for the Bulls series. He picked them up from the airport and drove them to the team hotel. When Charlie stepped off of the elevator to head to the stadium, Alex ran out and gave him a big hug. Another time, as the Bulls endured an eight-game losing streak on the road and Charlie hadn't seen his family in almost two months, Cahalane traveled to each game, supporting him from the stands.

"It's a really good friendship," Montoyo says of Cahalane. "He'd be my friend even if I weren't in baseball -- and that's what I like about him."

Alex underwent his first major open-heart surgery just seven days after he was born. Among hospital and hotel stays, medications and more, the Montoyos saw that their expenses would quickly grow. They had a modest house, drove an old car and lived "like minor league people," Sam says. While they had some money saved, they didn't have the expansive amount they would need in the ensuing months and years.

As they pondered what to do, a friend told Montoyo about B.A.T., the Baseball Assistance Team. Founded in 1986, the MLB-affiliated organization provides confidential financial assistance to applicants who need financial help for a variety of reasons, whether medical bills, retirement care, obtaining a college degree and the like.

B.A.T. began as a handful of former players who wanted to help retired major leaguers in financial distress; it has grown into an organization that also assists minor leaguers, umpires, scouts, major and minor league front-office personnel, former Negro League players, widows and more.

"Really, the entire baseball family," Erik Nilsen, the executive director of B.A.T., says. "If someone has had a pro baseball-related paycheck for at least two years, they're eligible to apply for a grant."

Last year, B.A.T -- which has a staff of five and a board of 15 members, mostly retired MLB players -- received 475 grant applications, and the organization spent $4.5 million to help applicants.

When the Montoyos learned that they'd need to spend several months in L.A. for Alex's first UCLA-based surgery, Sam called Jim Martin, then B.A.T. executive director, in tears. It was November 2007, at 8 on a Saturday night. A few hours later, the B.A.T. board held an emergency midnight call and approved the Montoyos for a grant.

"The medical care wasn't the problem --- insurance covered those things," Sam says. "What it didn't cover was how the hell you move to another state and take care of your kids." She found a one-bedroom apartment in Westwood that was a five-minute walk to the hospital, utilities included, with a month-to-month lease; the rent was $4,800 per month. While Charlie's former and then-current teams in Montgomery, Alabama, and Durham held fundraisers for the family, the bills still grew.

Throughout the fall of 2007 and winter of 2008, as the Montoyos waited for Alex's body to grow strong enough for him to breathe without his ventilator, they lived in Los Angeles. Sam went to the hospital each day while Charlie and Tyson played at home; Charlie took the hospital night shift. In March, Alex was finally discharged. The Montoyos flew home to Tucson; two days later, Charlie left for spring training.

Once back home, though, their medical challenges -- and costs -- mounted. Alex's prescriptions totaled around $1,100 a month. He had to learn to use a feeding tube and couldn't eat solid foods until he was 3. Sam enlisted a feeding-tube therapist to come twice a week to teach Alex to eat. Her rate was $400 per hour.

The pediatrician told Sam that Alex needed a helmet, which was considered "cosmetic" and thus not covered by insurance. A physical therapist came to the house twice weekly to teach Alex how to walk and move; an occupational therapist taught him speech therapy, because one of his vocal cords had been paralyzed during a surgery.

Because Charlie was with his team across the country, Sam slept in Alex's room each night, administering nighttime medications when he needed them. After months of cumulative exhaustion from her sleep-interrupted nights, B.A.T. funding allowed Sam to hire a special-needs physical therapist who came to the house two nights a week; on those nights, Sam slept in her own room for a solid eight-hour stretch.

"They were always right there," Sam says of B.A.T. "They said, 'You do what you have to do, and we'll take care of it.'"

In 2003, B.A.T. began a payroll deduction program, whereby major league players could opt to have a portion of their paycheck deducted each year to go toward B.A.T. Representatives from B.A.T. visit each team during an annual spring-training fundraising tour, explaining the purpose of the organization and asking recipients to share testimonials of how the funding has affected their lives. Nearly 1,600 players, coaches and managers from all 30 teams donated a record $3.4 million this past spring.

"It's always good seeing people in a better situation once we're done assisting, rather than a worse spot," Nilsen says. "That's the ultimate goal -- being a short-term bridge."

Each year, the American League and National League teams that collectively donate the most funds each receive the Bobby Murcer Award. During spring training this year, Montoyo spoke to the Blue Jays, opening up about how much B.A.T. had helped his family over the years. The Blue Jays collectively donated over $200,000, winning the AL award for the first time.

The Cahalane family began its annual visits to Montoyo at spring training several years ago. While two of the Cahalane children are now in college, Scott still visits every spring. Montoyo called Scott on the day he accepted the Blue Jays job last fall. Ashley, now a rising senior at Central Florida who plans to work with children with special needs following graduation, has grown particularly close to Montoyo, whom she calls "Uncle Charlie."

While Alex's surgeries, by all indications, were successful, the side effects have remained. He will likely eventually need surgery on his right leg, which is longer than his left one. He has secondary cerebral palsy and has difficulty writing because of limited motor skills in his right hand, so he uses a computer to type notes in school, and his hands tire quickly regardless of the activity.

Still, "for what he's got going on, he's doing great," Sam says.

Beginning in 2010, the Montoyo family began joining Charlie in Durham once the school year ended, a practice they continued when he joined the Rays' big league staff.

While Tyson loves being around his dad, he doesn't love being around baseball all the time. He is a lacrosse player, and he loves playing video games. Alex, while he doesn't play organized sports, loves playing outside and P.E. class. And he always wants to be at the ballpark. He typically arrives in the early afternoon, rattling off the lineup to the players, walking around the clubhouse to offer handshakes and high-fives -- and flashing his big, all-encompassing grin.

"When people say, 'Oh this guy lights up the room,' they don't always mean it," Kiermaier says. "But when you talk about Alex, it's no cliché; he puts a smile on everyone's face. He's such a goofy, fun-loving kid, and he's so sincere about everything. He just makes your day."

Kiermaier remembers telling Alex, who then weighed 68 pounds, that he needed to work on his strength training. He asked if he could bench-press Alex, who responded, "No way!" But Kiermaier persisted: "Alex, it's for the team!" Alex relented, so Kiermaier lay on the bench, hoisted Alex above him, and bench-pressed him eight times. "I told him I'd hit a homer that night. I didn't hit a homer, but I did hit a deep double," Kiermaier says, laughing.

Alex excels at video games, particularly Fortnite, and several Rays are his favorite co-players. Rays pitcher Blake Snell said he and Alex hung out almost every day in 2017. "When Alex wouldn't come to the clubhouse, I'd be upset," the 2018 American League Cy Young Award winner says. The two played video games together, talked baseball and just hung out. "Every time he came to the park, it always made my day better."

Montoyo is only the third Puerto Rican native to become a big league manager, and he is leading a team with two sons of former major leaguers on the active roster: Vladimir Guerrero Jr. (son of Hall of Famer Vladimir) and Cavan Biggio (son of Hall of Famer Craig). Montoyo appreciates the father-son bond, whether through baseball or outside of it. And because of baseball, his and his family's circle has grown much wider, thanks in large part to his affable nature, and the friends they've made throughout their journey, including the Cahalanes.

"I don't care if he's the manager of the Blue Jays or the plumber down the street, because it's not about what he does," Scott Cahalane says. "Every time he sees my wife and kids, no matter what's going on in his life, he's Uncle Charlie, smiling and giving them big hugs. There's a reason we became friends."

And as that friendship has evolved, so has Montoyo. He took the long road to the majors, enduring trials along the way, but at 53 he can take the broad view.

"Going through all of this with Alex, it made me a better man," Montoyo says. "Because now, if it's bases loaded, two outs ... I know, 'OK, it could be worse.'

"It's all given me perspective."