I think the photo is real.
Rick Wilking is a well-known Reuters photographer. It would be the end of his career if he submitted a fake picture.
He got lucky with a photo. I have no idea what other scribbles he's picked up taking shots of people taking notes.
A lot is being read into the note, which basically informs Rice that whatever is scheduled next, or whatever breaks are coming up, that a bathroom break is going to be part of it.
I've written notes like that myself in meetings.
Let the Democrats have their fun. They shot their foot off again last week, and they're owly.