As the debate ended, Obama, McCain, and moderator Bob Schieffer stood up to shake hands. Because of the table shape and size, after Obama and Schieffer first shook hands, McCain found himself too far from Schieffer to reach for a handshake, so he briefly made a face and gesture as he changed course to step around the table to reach Schieffer.
The television camera's perspective clearly showed what McCain was doing and his behavior was easy to see as light-hearted jest. This photo's perspective captures the moment in a manner which conveys an entirely different connotation. Some may think this is a Photoshop'd image, but the moment did happen.