Actual Reuters photo and caption, via First Draft via Atrios:
U.S. President George W. Bush writes a note to Secretary of State Condoleezza Rice during a Security Council meeting at the 2005 World Summit and 60th General Assembly of the United Nations in New York September 14, 2005. World leaders are exploring ways to revitalize the United Nations at a summit on Wednesday but their blueprint falls short of Secretary-General Kofi Annan’s vision of freedom from want, persecution and war.
If you look closely, here’s Bush’s note to his Secretary of State while the entire world is trying to figure out how to make the United Nations work:

I did a little contrast work in Photoshop, but you can compare to the original with your own eyes.
The most powerful man in the world, and he’s not even sure if he’s allowed to pee.

