The caption reads:
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.
The note reads:
"I think I MAY NEED A BATHroom break? Is this possible."
Of course you cant actually see his face, or anything other than the back of part of his head, part of a desk, a stack of papers and of course the note, so there is a good chance someone rigged it and managed to fool Reuters and then the story started to spread on the internet.
If this is real someone really needs to come up with code words for George W Bush to use at embarassing moments. Things like "I need to take a call from the LOOuisiana Governor", or "I would like to consult with the SUPREME Court".